spt dollar dan rupiah beserta lampirannya

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MINISTRY OF FINANCE OF REPUBLIK OF INDONESIA DIRECTORATE GENERAL OF TAXES

INSTRUCTION FOR THE COMPLETION OF INCOME TAX RETURN FOR CORPORATE

GENERAL INSTRUCTION

In accordance with the Law Number 6 of 1983 concerning General Provisions and Tax Procedures as lastly amended by Law Number 16 of 2009, Taxpayers should pay attention to several things below: 1. Any Taxpayer should be required to complete and file its Annual Tax Return truly, completely, and

clearly and also sign it.

2. The Tax Return shall be signed by the Taxpayer or his/her authorized proxy/representative.

3. The Tax Return shall be assumed not filed if it is not signed or it is not fully provided with details

and/or documents as regulated by Minister of Finance Decree No. 534/KMK.04/2000, Minister of Finance Regulation No. 181/PMK.03/2007 and Director General of Taxes Decree No. KEP-214/PJ./2001.

4. Any Taxpayer shall collect his/her own annual tax return to tax office (KPP)/ taxation and

consultation office (KP2KP) or can be downloaded through website www.pajak.go.id and file it not later than 4 (four) months after the end of taxable year .

5. The tax return may be directly delivered in to the tax office where the tax payer is registered or

other places regulated by the Director General of Taxes which is : Tax corner, Tax mobile and specific appointed tax return receiving places (Drop Box) or send it by registered mail through post office or some other ways as regulated by Minister of Finance Decree No. 181/PMK.03/2007 as amended by Minister of Finance b Regulation Number 152/PMK.03/2009

6. Any underpayment shall be paid in full before the tax return filed. Failure to make full payment within such a period shall result in an administrative sanction in the form of a monthly interest of 2 % (two percent) from the due date of payment to the date on which the full payment is made. Any portion of a month shall be considered as a full month.

7. The Taxpayer shall be required to make tax payments to the State Treasury through a Post Office or banks designated by the Minister of Finance.

8. The Director General of Taxes may – at the request of a Taxpayer – approve a tax to make an instalment or a deferral of tax payment, including any underpaid tax in the annual tax return (income tax article 29) for a period not exceeding a 12 (twelve) month period. Under Director General of Taxes Decree No. PER-38/PJ/2008, the request shall be submitted in writing to the head of a tax office in which the Taxpayer is registered, at the latest 9 (nine) working days before payment due date, using a designated form attached in attachment Form- I on that decree.

9. The Director General of Taxes may – at the request of a Taxpayer – extend the filing period of an annual tax return for no later than 2 (two) months. The request shall be made in writing, accompanied with a statement of one-tax-year's interim tax due and its proof of payment.

10. Failure to file the Annual Tax Return within the specified period or an extended period shall result in an administrative fine of Rp 1,000,000 (one million rupiah).

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11. Book of accounts in English language and United State Dollar currency is able to be applied by Taxpayer after getting permission from Ministry of Finance. Taxpayer who allowed to have a book of accounts in English language and United State Dollar Currency shall apply the Corporate Annual Income Tax Return and its attachments in Bahasa (except an attachment in the form of financial statement) and in dollar united state currency. This agreement arranged in Ministry of Finance Regulation Number 196/PMK.03/2007.

12. Anyone who – by reason of negligence or deliberately – fails to file an Annual Tax Return, or files one incorrectly, or not completed, or furnishes false information which may causes to the Government, shall be subject to administrative sanctions and / or criminal sanctions in accordance with the provisions of the applicable legislation.

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INSTRUCTIONS FOR THE COMPLETION

Income Tax Annual Return year of 2009 is using a form which is able to read by scanning machine, therefore, Taxpayers need to comply with the following conditions:

1. If the Taxpayer makes the Annual Tax Return forms itself, not to forget to make (black square) on every corner as border so that the document can be scanned.

2. Use the paper size F4/Folio (8.5 x 13 inch) with minimum weight of 70 gram.

3. Paper should not be fold or rumpled.

4. Identity column : for Taxpayers using typing machine, when filing unstructured column (such as Taxpayer’s name, Type of Business and Origin Country of Head Office (for PEE)), letter boxes can be ignored as long as the writing does not over the right border. For structured filling (such as Taxpayer’s Identification Number, Phone Number), each number should be written in a letter box.

Example of Filling:

TIN :

Taxpayer’s Name : PT. MAJU MAKMUR SENTOSA JAYA

Types of Business : WOOD FURNITURE INDUSTRY

Telephone No. :

Notes: for those using computer or hand writing, all filling should be in letter boxes.

5. In filling monetary values in rupiah or United State Dollar currency, the number should be written without decimal places. Example:

a. In writing ten million rupiah is: 10.000.000 (NOT 10.000.000,00)

b. In writing a hundred twenty five rupiah fifty cent is 125 (NOT 125,50)

0 7 2 3 4 5 6 7 8 0 1 2 0 0 0

0 7 2 1 1 2 3 4 5 6 7 8

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Item 1 : DOMESTIC NET COMMERCIAL INCOME

Domestic commercial net income is the net income according to Indonesian accounting principles, namely all incomes received and obtained from business activities and from non-business activities in Indonesia including income imposed by Finalized Tax and non taxable object, deducted with expenditures/costs to obtain, bill, and maintain income in accordance with the Indonesian accounting system and method which is followed consistently as reflected in the commercial financial statement, before adjusted according to Income Tax Law and its implementing regulations.

a. GROSS INCOME

Fill with the gross amount of business activities in Indonesia, after less of sales return and discount, for trade and industrial company in the taxable year concerned.

b. COST OF SALES

Fill with cost of sales from Taxpayer’s business activity. If according to accounting system and method followed by particular Taxpayers (e.g. banks, pension fund, mutual fund, social organizations, associations etc.) there is no costs separation or classification for cost of sales, then all costs are reported into point c: others expenses.

c. OTHER OPERATING EXPENSES

Fill with expenses which are not included in cost of sales.

d. NET INCOME FROM BUSINESS (1a – 1b – 1c)

Net income is calculated from sales deducted by cost of sales and others expenses.

e. INCOME FROM NON BUSINESS ACTIVITIES

Fill with gross amount of income received and or obtained from non business activities as stated in point a, for example: income from capital investment in Indonesia, gain from sales/transfers/leases of assets, and other incomes which are not included in income from business activities or not related with business activities.

f. EXPENSES FROM NON BUSINESS ACTIVITIES

Fill with direct expenses relevant to the income from non business activities as stated in point e.

g. NET INCOME FROM NON BUSINESS ACTIVITIES (1e-1f)

Fill with amount from point e deducted by point f.

h. Total (1d + 1g)

Sufficiently clear

Item 2 : FOREIGN COMMERCIAL NET INCOME

Fill with the net income received or obtained from overseas as stated in special form 7A/7B column (5) ‘Net Amount’.

Item 3 : TOTAL NET COMMERCIAL INCOME (1h + 2)

Fill with net commercial income from domestic and overseas.

ATTACHMENT – I (FORM 1771 – I AND FORM 1771 – I / $)

CALCULATION OF FISCAL NET INCOME

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Item 4 : INCOME SUBJECT TO FINALIZED INCOME TAX AND NON TAXABLE INCOME

In order to calculate the net amount of taxable income according to general provisions, income from Indonesia which is imposed by Finalized Tax and non taxable objects must be deducted so as the net taxable income (number 8) will be zero/nil. Fill with the commercial net income from income which is imposed by Finalized Tax and commercial net income from non taxable objects that has already been recorded in number 1 form 1771-I; in case of experiencing commercial loss , fill with the amount of commercial loss.

Item 5 : POSITIVE ADJUSTMENTS

Positive adjusment for tax purpose is the adjustment of commercial net income (excluding income which is imposed by Finalized Tax and non taxable objects) in order to calculate Income Tax according to Income Tax Law and its implementing regulations, which increases the income and or reduces commercial costs stated in number 1.

a. Adjustments based on Article 9 paragraph (1) subparagraph b of Income Tax Law, corporate expenditures to buy/fix private houses or cars, private/family travel expenditures, private/family insurance premium expenditures, and other expenditures for stockholders, partners, or members, must be excluded from corporate expenses.

b. Adjustments based on Article 9 Paragraph (1) Subparagraph c of Income Tax Law, the formation and maintenance of reserved fund must be excluded from corporate expenses. However for certain businesses that economically requires to form reserved fund to cover expenses and loss in the future, it is still allowed to consider it as expenses, but limited to:

1. Allowance for Doubtful Accounts for bank industry and other entity which is transferring a

credit , leasing with option right, multifinance and factoring companies;

2. reserve for insurance, include reserve for social aids generated by Badan Penyelenggara Jaminan Sosial (Committee of social Security)

3. reserve of security for LPS

4. reserve of reclamation cost for mining sectors

5. reserve of replanting cost for forestry sector

6. reserve of shut-down and maintenance cost of the banishment of industrial waste for industrial-waste processing sector

See : * Minister of Finance Regulation Number 81 / PMK.03 / 2009 .

c. Pursuant to Article 4 Paragraph (3) Subparagraph d of Income Tax Law, consideration or remuneration in the form of benefit in-kinds in relation with employment or services is not

See : * Minister of Finance Regulation Number 83/PMK.03 /2009;

d. Adjustment pursuant to Article 9 Paragraph (1) Subparagraph f of Income Tax Law, payment of salary, honorarium, and other rewards referring to passed to service or work given to stockholders or other related parties as stated in Article 18 Paragraph (4) of Income Tax Law, can be burdened as expense of a company as long as its amount does not exceed fairness. Fairness is measured based on common standards for the same qualification of work which is done by non related parties. The difference exceeding fairness may be considered as distribution of profit.

e. Pursuant to Article 4 Paragraph (3) Subparagraph a of Income Tax Law, aid or donation and grant received by religious bodies, education institutions, social bodies, or small enterprises including cooperation as regulated by the Minister of Finance, are not considered income as long as there is no relationship based on business, employment, ownership, or control among related parties. Therefore according to the taxability and deductibility principle, adjustment according to

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Article 9 Paragraph (1) Subparagraph g of Income Tax Law, the aid or donation and grant given by Taxpayers can not be burdened as expenses.

See : Minister of Finance Decree Number 604/KMK.04/1994.

Tithe or Zakat paid by corporate Taxpayer owned by moslem can be deducted from gross income to calculate Taxable Income under these conditions:

The taxable income entitled to be tithed has already been reported in the Annual Tax Return; The zakat is delivered through Amil Zakat Body (BAZ) or Amil Zakat Institution (LAZ) formed or

approved by Central/Local Government;

Therefore non income zakat and zakat from income which does not fulfil those conditions above are not allowed to be burdened as expense.

f. Adjustments pursuant to Article 9 Paragraph (1) Subparagraph h of Income Tax Law, Income Tax and Tax Credit are not considered as company’s expenses.

g. Pursuant to Article 4 Paragraph (3) Subparagraph i of Income Tax Law, part of a profit received or obtained by member of partnership whose capital is not divided into shares, partnership, association, firms, and kongsi is not considered as income. Therefore according to taxability and deductibility principle, the adjustment pursuant to Article 9 Paragraph (1) Subparagraph j of Income Tax Law, for those stated entities, payment of salary to their members can not be burdened as expenses.

h. Adjustments pursuant to Article 9 Paragraph (1) Subparagraph k of Income Tax Law, administrative penalty in terms of interests, fines, and increases of tax, and criminal penalties in terms of fines following tax laws are not considered expenses to the company.

i. Fill according to Special Attachment of I A / I B list of Depreciation and Amortization Fiscal.

j. Fill according to Special Attachment of I A / I B list of Depreciation and Amortization Fiscal.

k. Adjustments pursuant to Article 7 Government Regulation Number 138 of 2000, DGT Decree may determine certain times for cost recognation for certain Taxpayers following the Government policy.

See : * DGT Decree Number Kep- 184/PJ./2002; * DGT Circular Number SE- 08/PJ.42/2002.

l. Adjustments according to general provision article 4 and Article 6 and their implementing regulations, in case of:

There is income which is not recognized commercially but considered as Taxable Object imposed by non Finalized Tax;

There are other company’s expenses or loss which are commercially recognized but are not recognized for the tax purpose;

There is overseas loss whether from Permanent Establishment (PE) or not, after adjusted for the tax purpose.


DGT Circular Number SE-04/PJ.42/2002; DGT Circular Number SE-01/PJ.33/2005.

Item 6 : NEGATIVE ADJUSTMENTS

Negative adjusment for tax purpose is the adjustment of net commercial income (excluding income which is imposed by Finalized Tax and non taxable object in order to calculate Income Tax according to Income Tax Law and its implementing regulations, which is reducing the income and or increasing commercial costs stated in number 1.

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a. Fill according to Special Attachment of I A / I B List of Depreciation and Amortization Fiscal.

b. Fill according to Special Attachment of I A / I B List of Depreciation and Amortization Fiscal.

c. Adjustment pursuant to Article 7 of the Government Regulation Number 138 of 2000, DGT Decree may determine certain times for revenue recognation for certain Taxpayers according to the Government policy.

See : * DGT Decree Number Kep-141 / PJ. / 1999; * DGT Decree Number Kep-563 / PJ. / 2001; * DGT Decree Number Kep-184 / PJ. / 2002; * DGT Circular Number SE-08 / PJ.42 / 2002.

d. Adjustment pursuant to Article 6 of Income Tax Law and its implementing regulations, in case a company has other expenses or loss which are commercially not recognized but fiscally recognized.

Item 7 : INVESTMENT ALLOWANCE

Item 7a Fill with what period the facilities have been used

Item 7b Fill with the amount of net income deduction facilities for investment which has already been approved by an authoritative officer as mentioned in the list of investment facilities number 5b (Tax Return Special Attachment 4A/4B).

Item 8 : FISCAL NET INCOME

Fill with the result of number 3 deducted by number 4 added by number 5m deducted by number 6e deducted by number 6e deducted by number 7b.

ATTACHMENT II

( FORM 1771 – II and FORM 1771 – II / $ )

DETAIL OF COST OF SALES, OPERATING EXPENSES AND NON OPERATING EXPENSES

Fill with detail of Cost of Sales, Operating Expenses and Non Operating Expenses taken from Form 1771-I point 1 item b, c, and f.

Column (1) Fill according to numbers in sequence

Column (2) Details

Column (3) Fill with expenses included in Cost of Sales

Column (4) Fill with Operating Expenses excluded from Cost of Sales

Column (5) Fill with Direct Cost relevant to non-business income

Column (6) fill with the result of Column (3) added with Column (4) added with Column (5)

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ATTACHMENT III

( FORM 1771 - III and FORM 1771 – III / $ )

DOMESTIC TAX CREDIT

Fill with detail of Income Tax Article 22 and Income Tax Article 23 / 26 Withholding Receipts for incomes which are imposed by non-Finalized Tax Income received/obtained and reported in current Annual Tax Return.

The withholding of Income Tax Article 26 that can be credited with Income Tax Due for the taxable year concerned is the tax withholding as mentioned in Article 26 paragraph (5) of Income Tax Law.

Column (1) Fill with the numbers in sequence for each type of taxes Column (2) Fill with Name of Withholding Agent. In term of Income Tax Article 22 paid by

taxpayer him/herself, filled the column with the name of Bank. Column (3) Fill with TIN of Withholding Agent. In term of Income Tax Article 22 paid by Taxpayer

him/herself, filled the column with the address of Bank. Column (4) Fill the column with:

- Fill with Type of Transaction or Payment for Income Tax Article 22 - Fill with Type of Income tax withheld for Income Tax Article 23 and Article 26

Column (5) Fill with the amount that is basis of Withholding Column (6) Fill with the amount of Income Tax Withheld

For Income Tax Article 22 who paid by his/her own, Column (6) shall be filled with the word “SSP” or “SSPCP”.

Column (7) Fill with Number of Withholding Tax Receipt. Column (8) Fil with Date of Withholding Tax Receipt with writng format dd/mm/yy

Taxpayer shall be obliged to show and gave a Withholding Notice of third parties if being asked for tax audit purposes.

ATTACHMENT IV

( FORM 1771 – IV AND FORM 1771 – IV / $ )

FINAL INCOME TAX AND NON TAXABLE INCOME

This Attachment shall be filled with certain incomes that is imposed by Finalized Tax whether withheld by other parties or paid by Taxpayer himself and other incomes excluded from Taxable Object received or obtained during the year, according to gross amount or the value of transaction. Taxpayer is obliged to show and make a list of Tax Withholding Notice if being asked for tax audit purpose.

Income from derivative transaction in the form of futures contract that is traded in stock exchange is considered as non taxable income according with the unvalid of Government Regulation No.17 of 2009 Article 2, Article 3 paragraph (1), (2) and (3) and Article 5. Therefore, the column shall not be filled.

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ATTACHMENT V

( FORM 1771 – V and FORM 1771 – V / $ )

LIST OF SHAREHOLDERS/OWNERS AND TOTAL DIVIDENDS DISTRIBUTED

LIST OF DIRECTORS AND COMMISSIONERS

Part A : LIST OF SHAREHOLDERS/OWNERS AND TOTAL DIVIDENDS DISTRIBUTED

- Column (1) fill according to a numbers in sequence.

- Column (2) fill with the name of shareholders/capital owners according to ID card.

- Column (3) fill with the address of shareholders/capital owners according to ID card.

- Column (4) fill with Taxpayer’s identity number of shareholders or capital owners. For shareholders or capital owners who do not have a Taxpayer’s Identification Number (for example non-resident Taxpayers, Taxpayers who have income below personal Tax Exemption limit) fill with “none”.

- Column (5) fill with amount of capital deposited.

- Column (6) fill with percentage of ownership.

- Column (7) fill with amount of dividend to shareholders.

Part B : LIST OF DIRECTORS AND COMMISSIONERS

- Column (1) fill according to numbers in sequence

- Column (2) fill with the name of shareholders / capital owners according to ID card.

- Column (3) fill with the address of shareholders / capital owners according to ID card.

- Column (4) fill with Taxpayer’s Identification Number of shareholders or capital owners. For shareholders or capital owners who do not have Taxpayer’s identity number (for example non-resident Taxpayers, Taxpayers who have income below the non-taxable income) fill with “none”.

- Column (5) fill with position of board of directors or commissioners.

Notes:

Foundation Taxpayers and other bodies which are not owned on the basis of capital ownership, as well as KIK mutual fund and KIK – EBA, fill the list of share holders / capital ownership with the statement: “none”, in column (2).

Taxpayers whose companies are listed in the stock market, public shareholders have no obligation to write in detail per name (can be stated cumulatively) except if the ownership of shares amounts to 5% (five) or more from the amount of capital deposited.

List of structure of board of directors and comissioners must be filled completely but without those at managerial positions.

See : DGT Circular Number SE-02/PJ.42/2003

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ATTACHMENT VI

( FORM 1771 – VI and FORM 1771 – VI / $ )

LIST OF CAPITAL INVESTMENT IN AFFILIATED COMPANIES

LIST OF LOANS (ACCOUNT PAYABLE) FROM SHAREHOLDER AND/OR AFFILIATED COMPANIES

LIST OF LOANS (ACCOUNT RECEIVABLE) TO SHAREHOLDER AND/OR AFFILIATED COMPANIES

1. Those lists above must be fill with end of year balance based on transcript of citation of elemens from financial statements attached to Annual Tax Return.

2. Equity participation declared is the equity participation in other companies which falls to the category of related parties.

3. Account Payable/receivable declared are the loans from / to other related parties.

4. Taxpayers who have no equity participation or have equity participation but do not fall to the category of related parties and Taxpayers who have no account payable/recievable from/to other related parties, fill the list with “none”, in column (2).

PRIMARY TAX RETURN

( FORM 1771 and FORM 1771 / $ )

TAXABLE YEAR : Fill available boxes with company’s yearbook and period of company’s yearbook.

Example: Yearbook 2010

If a Taxpayer file amended tax Return, fill “X” in the appropriate box and fill in the blank next the box with a number of the tax return have been amended. But, if a Taxpayer file a normal Tax Return, a box is unnecessary to be filled.

IDENTITY

Taxpayers Identification Number /

(NPWP) : Fill according to Taxpayers’ Identification Number as stated in the NPWP card.

Taxpayers’ name : Fill according to name as stated in the NPWP card.

Types of Business : Fill according to business classification of the company. In the case where there is more than one type of businesses, then state the most prominent/core business.

2 0 1 0

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Business classification : For the code of Business Classification Number (KLU), fill according to the Director General of Taxes Decree Number KEP-34/PJ./2003. If the information is not clear, please contact the tax office where you are registered.

Telephone Number : Fill according to Taxpayer’s number telephone. Number telephone is obliged to filed by Taxpayer.

Facsimile Number : Fill according to Taxpayer’s Facsimile number. Faximile Number is obliged to filed by Taxpayer.

Accounting Period : Fill according to Taxpayer Accounting Period For instance Taxpayer use Period January – December

Period January – December Period April – Maret

Foreign Domicile of Head Office : Fill according to name of domicile country of head office of the permanent established bodies overseas according to the Agreement for The Avoidance of the Double Taxation; or in the cases where an agreement are not yet concluded, following the Indonesian tax laws.

FINANCIAL STATEMENT : In case of having books of account in US Dollars state the number and date of the approval letter from Director General of Taxes, as well as the year started. State whether the financial statement of the company for the current yearbook is “audited” or “not audited” by a public accountant, by filling the appropriate box with “X”. In case the company is audited, state the opinion of the public accountant in the boxes available according to the code number below:

1 - for opinion : Unqualified Opinion 2 - for opinion : Qualified Opinion 3 - for opinion : Adverse Opinion 4 - for opinion : Disclaimer of opinion

Name of Accounting Firm : Fill according to name of Accounting Firm who signed the audit report

TIN of Accounting Firm : Fill according to TIN of Accounting Firm in case the company

was audited by a public accountant Name of Public Accountant : Fill according to name of Public Accountant who signed the audit

report

Name of Tax Consulting Firm : Fill with the name of Tax Consulting Firm according to the power of attorney letter and the name of tax consulting firm . TIN of Tax Consulting Firm : Fill with TIN of Tax Consulting Firm in the events of performing

their tax duties and rights, a Taxpayer uses the services of a tax consultant.

0 1 1 0 to 1 2 1 0

0 4 1 0 to 0 3 1 1

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Name of Tax Consultant : Fill with the name of tax consultant according to the power of attorney letter

TIN of Tax Consultant : Fill with TIN of Tax Consultant according to the power of attorney.

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A. TAXABLE INCOME:

Item 1 - FISCAL NET INCOME

Fill with amount of Fiscal Net Income from form 1771-I number 8 column (3)

Item 2 - .LOSS CARRIED FORWARD

Loss carried forward from past tax years according to Article 6 Paragraph (2) of Income Tax Law or because of receiving tax investments facilities in the form of longer compensations of the loss. Fill from the calculation of the compensations of the loss carried forward the amount of this tax year column (special attachment of the tax returns). Fill with the amount of loss carried forward of the column “this tax year” from the special

Attachment 2A/2B Calculations of the Loss Carried Forward. Fill with number “0” (zero), if item 1 says loss (negative).

(See example of fillings of special Attachment form 2A/2B)

Item 3 – TAXABLE INCOME Fill with calculations of number 1 deducted by number 2.

B. INCOME TAX DUE:

Item 4 - TAX DUE Choose one of these rate calculation of Income tax due in accordance with Taxpayer conditions and fill ”X” in the available box.

a. Income Tax Rate of Article 17 paragraph (1) subparagraph b This rate apply to domestic corporate and Permanent Establishment is 28%. However, according to the Article 17 paragraph (2a), the tariff become 25% since the taxable year of 2010, Tax due is calculated by multiplying rate of Income tax and taxable income.

Example: The amount of gross income for FY 2010 is IDR 54.000.000.000,00 The amount of taxable income for FY 2010 is IDR 4.000.000.000,00 Tax Due is = 28% IDR 4.000.000.000,00 = IDR 1.000.000.000,- If Corporate Taxpayer is imposed by tariff stated in Income Tax Law Art. 31E if its gross income is

about Rp 50.000.000.000,00 (fifty billion rupiah).

b. Income Tax Rate of Article 17 paragraph (2b)

This rate apply to Listed Company that have ownership at least 40% of all shares traded in Indonesia Stock Exchange and fulfill other certain requirement. This type of Taxpayer can get 5% lower tariff than tariff stated in Inc. Tax Law No.36/2008 Art. 17 paragraph (1) subparagraph b and paragraph (2a).

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Example: Taxable Income FY 2010 = Rp 1.250.000.000,00 Income tax due = (25% - 5%) x Rp 1.250.000.000,00 = IDR 250.500.000,00

See : Government Regulation Number 81/2007

c. Income Tax Rate of Article 31E Domestic entity Taxpayer which has gross profit up to Rp 50.000.000.000,00 (fifty billion rupiah) get special deduction 50% of tariff stated in Inc. Tax Law No.36/2008 Art. 17 paragraph (1) subparagraph b and paragraph (2a). that imposed to taxable income which as a portion of gross profit up to Rp 4.800.000.000,00 (four billion and eight hundred million rupiah). Calculation of this terms can be divided into two ways: 1. If taxable income is up to IDR 4.800.000.000,00 ; Income tax due = 50% x 28% x Taxable Income 2. If taxable income in between IDR 4.800.000.000,00 and IDR 50.000.000.000,00, the

calculation of tax due is :

Income Tax Due

= (50% X 25%) X Facilitated

Taxable Income +25% X Unfacilitated Taxable

Income

The calculation of facilitated taxable income ;

Rp 4.800.000.000,00 X total taxable income

Gross Income

The calculation of unfacilitated taxable income ;

Unfacilitated taxable income = Total Taxable Income – Facilitated Taxable Income

Example 1): Gross income of PT Y in FY 2010 is Rp 4.500.000.000,00, while taxable income is IDR 500.000.000,00. The counting of tax due = taxable income is multiplied by 50% tariff of current enterprise’s Income Tax Rate because the amount of gross income not more than IDR 4.800.000.000,00. Tax due = 50% x 25% x IDR 500.000.000,00 = Rp 62.500.000,00 Example 2): Total gross income of PT ”X” amounted IDR. 30.000.000.000,00 in taxable year of 2010, taxable income is IDR 3.000.000.000,00. Calculation of Income Tax Due is as follows:

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Total facilitated taxable income = (IDR 4.800.000.000,00 : IDR 30.000.000.000,00) x IDR 3.000.000.000,00 = IDR 480.000.000,00

Total of unfacilitated taxable income = IDR 3.000.000.000,00 – IDR 480.000.000,00 = IDR 2.520.000.000,00

Income Tax Due = (50%x 25% x IDR480.000.000,00) + (25% x IDR2.520.000.000,00) = IDR 60.000.000,00 + IDR 630.000.000,00 = IDR 690.000.000,00

Note: for tax rate application purposes, the total of taxable income must be rounded down in full thousand rupiahs;

Item 5 – ADJUSTMENT FOR FOREIGN TAX CREDITS REFUNDED AND HAD BEEN CREDITED

IN THE PREVIOUS YEAR’S RETURN (Income Tax Art.24)

In cases of obtaining tax deductions or refund from tax payable/paid overseas (income tax Article 24), which has been already calculated as income tax credit payable in the previous year, fill with amount of tax deduction or refund.


Item 6 – TOTAL OF TAX DUE Fill with amount of calculations of number 4 added by number 5. C. TAX CREDIT

Item 7 – Tax Borned By The Government

In case where Taxpayer is granted with a facility in the form of Income Tax Borned by the Government for income received or derived by main contractor, consultant and supplier of a Government project funded by foreign grants or foreign loans, please fill with the amount of non finalized income tax calculated using the following formula:

THE AMOUNT OF FOREIGN LOAN / GRANT ----------------------------------------------------------- X INCOME TAX DUE TOTAL PROJECT COSTS

See:

Government Regulation Number 42 of 1995 as lastly amended by Government Regulation Number 25 of 2001;

Government Regulation Number 138 of 2000; Government Regulation Number 51 of 2008; Minister of Finance Regulation Number 187/PMK.03/2008;

Item 8 – Domestic and Foreign Tax Credit

a. : Fill with the amount of domestic tax credit taken from Form 1771-III column (6) / form 1771-III$ column (6) and column (7)

b. : Fill with the amount of foreign tax credit as calculated in the Special Attachment 7A/7B . c. : Sufficiently clear

Item 9 – Income Tax must be paid by Taxpayer/ Overwithheld Income Tax

Fill “X” in the appropriate box based on the amount resulted from subtraction of the amount in Point 6 with the amount in Point 7 and Point 8c.

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Item 10 – Income Tax paid by Taxpayer

Point a : fill with the amount of prepaid tax of Article 25.

Point b : fill with the principal amount of the income tax article 25 paid based on Notice of Tax Collection.

Point c : Sufficiently clear

D. INCOME TAX UNDER/OVERPAYMENT

Item 11

Fill “X” in the appropriate box based on the amount resulted from subtraction of the amount in Point 9 with the amount in Point 10e.

Item 12

Fill with the date of Income Tax Article 29 paid.

Item 13

Fill “X” in the appropriate box based on the request made.

Request of Pre-Audit Refund of Tax Overpayment performed by Taxpayer with certain

criteria as referred in Article 17C of Tax Law. Rules of determination of Taxpayer with certain criteria is as referred by Minister of Financial Regulation. Taxpayer with certain criteria is a Taxpayer who meet the requirement as follows: a. filing Tax Return timely; b. not having tax arrears for any type of tax, except for tax arrears having been granted

permission to be paid in installment or tax payment to be postponed; c. having Financial Statement whish is audited by Public Accountant or by government

financial supervisory institustion with unqualified opinion for 3 (three) consecutive years; and

d. never been convicted guilty of tax crime under a definite court verdict over the last 5 (five) consecutive years

(Minister of Finance Regulation No. 192/PMK.03/2007)

Request of Pre-Audit Refund of Tax Overpayment as referred to Article 17D of Tax Law performed by Taxpayer who meets a certain requirement. Limitation of total gross income, total supplies of taxable goods, and tax overpayment that can be given pre-audit are regulated by Minister if Finance Regulation. Pre-Audit Refund of Tax Overpayment can be given to Entities Taxpayer which is have: a. a total maximum of gross income according to Income Tax Return is five billion

(5.000.000.000,00) rupiahs; and b. a total tax overpayment according to income tax return less than ten million rupiahs

(10.000.000,00). Pre-Audit Refund of Tax Overpayment can be given to Taxable Person which is have: a. a total maximum of supply for one taxable period according to Value Added Tax Return

is four hundred million (Rp 400.000.000,00) rupiahs; and b. a total maximum of tax overpayment according to Value Added Tax Return is twenty eight

million (IDR 28.000.000,00) rupiahs. (Minister of Finance Regulation No.193/PMK.03/2007 as lastly amended by Minister of Finance Regulation No. 54/PMK.03/2009)

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E. MONTHLY INSTALLMENT OF INCOME TAX ARTICLE 25 FOR THE SUBSEQUENT YEAR

Calculation of monthly Income Tax of Article 25 for current year for all Taxpayers is based on income which is not subject to Finalized Tax

Item 14.

a. Income that shall be the basis for installment calculation, for:

Taxpayers in general, is based on regular income reported on the previous Annual Income Tax Return;

Banks and Financial Lease Companies, is based on net income reported on the last quarterly income statement that has been annualized and deducted by Income Tax Article 24 (previous year paid or due in overseas), then divide into 12 (twelve).

State Owned Enterprises/Local Government Owned Enterprises, is based on income projection on RKAP for current year that has been approved by RUPS and has been adjusted in accordance with Income Tax Law. In case where the RKAP has not been approved by RUPS, income projection based on the previous year RKAP that has been adjusted in accordance with Income Tax Law shall be used.

Listed company and other Taxpayer that based on the rule has to create Periodic Income Statement ; is based on net /loss income reported on the last periodic income statement that has been annualized and deducted by Income Tax Article 22, Art 23 and 24 (previous year paid or due in overseas), then divided into 12 (twelve).

See: Minister of Finance Regulation Number 255/PMK.03/2008 as amended by Minister of Financial Regulation Number 208/PMK.03/2009

b. LOSS CARRIED FORWARD

Fill with Calculation of Loss Carried Forward, amount in Current Year column (From Special Attachment 2A/ 2B)

c. TAXABLE INCOME

Fill with the amount of point 14a deducted by the amount of point 14b

d. TAX DUE

Fill with Taxable Income (point 14c) times tax rates specified in Article 17 (Part B number 4)

e. PREVIOUS YEAR’S AMOUNT OF TAX CREDIT ON INCOME WITHIN THE MEANING OF POINT 14a THAT HAS BEEN WITHHELD BY OTHER PARTY

Fill with the previous year’s amount of tax credit on income within the meaning of point 14a that has been withheld by other party (Income Tax Article 22, 23 and 24)

f. TAX SHOULD BE PAID AFTER WITHHOLDINGS (14d – 14e)

Fill with the amount of point 14d deducted by the amount of point 14e

g. Income Tax Article 25

Installment of Income Tax Article 25 (1/12 x line f), for:

Taxpayers in general, take effect since the fourth month of the current year;

State Owned Enterprises/Local Government Owned Enterprises, take effect since the first month of the current year;

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Banks and financial lease company take effect for the first three month in the current year, and for the next period, shall be calculated again every three months using the same method.

Listed company and other Taxpayer that based on the rule has to create Periodic Income Statement, Income Tax Article 25 applied to months before Periodic Income Statement submitted, and after that, recalculated each report periodic with the same way.

F. FINALIZED INCOME TAX AND NON TAXABLE INCOME

Item 15

a - FINALIZED INCOME TAX

Fill with the amount of income tax payable on income that is subject to Finalized Income Tax taken from Form 1771-IV and 1771-IV/$ Total Part A amount in Column 5 (JBA)

b. NON TAXABLE INCOME

Fill with the amount of gross income which is not tax object taken from Form 1771-IV and 1771-IV/$ Total part B amount in Column 3 (JBB).

G. STATEMENT OF RELATED PARTIES TRANSACTION

Item 16 Put “X” in one of the boxes available which is on number 16 point a or b. Taxpayer is obligated to fill, to sign and to attach special attachment 3A, 3A-1 and 3A-2, or 3B, 3B-1 and 3B-2 if there are special transaction and/or transaction with parties which is the resident of tax haven country.

Related Parties among Taxpayer could happen because of dependency or bond among each other which are caused by:

a. Ownership or Capital Share Related Parties is perceived exist if there is an ownership relationship with the capital share of twenty five percent (25%) or more , directly or indirectly

b. The mastery/control through management or the use of technology. Related Parties among Taxpayers could also be created because of the mastery/control through management or the use of technology, even though there is no relation of ownership.

Related Parties is perceived exist if one or more companies are under the same control. As well as the relation among some companies in that same control.

The criteria of tax haven country is as follow: a. Country which imposes low tax rates or not imposes tax income: or. b. Country which applies bank secrecy policy and does not conduct information exchange

Country which imposes low rate is a country that charges tax rate of income less than 50% of corporate tax rate in Indonesia. (for 2009 less than 14% and for 2010 less than 12,5%).

Country which applies bank secrecy policy and do not conduct the information exchange is country or juridiction that based on its current law prohibits to render of customer information, including for the purpose of tax related information. Regulation concerning further tax haven country will be regulated in Minister of Finance.

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H. ATTACHMENTS

a. Third copy of Tax Payment Receipt of Tax Settlement :

Must be enclosed by all Taxpayers, except if there is no final payment (nil). In case the Taxpayer pays the tax using e-payment system, please attach a valid tax payment receipt as a replacement for the third copy of Tax Payment Receipt;

b. Financial Statements (Compulsory For all Taxpayer)

Must be enclosed by all Taxpayers without exception. In case the book of account/financial statements have been audited by a public accountant, please attach the audited financial statements. For Taxpayers having subsidiaries in Indonesia or overseas, and or having branches in foreign countries either in the form of Permanent Establishment or not, Consolidated Financial Statements and Taxpayer’s Financial Statement shall be enclosed separately;

c. Transcript of Elements Citation of Financial Statement Must be enclosed by all Taxpayer in accordance with Special Attachment Form- 8A-1 / 8A-2 / 8A-3 / 8A-4 / 8A-5 / 8A-6 / 8A-7 / 8A-8 / 8B-1 / 8B-2 / 8B-3 / 8B-4 / 81B-5 / 8B-6 / 8B-7 / 8B-8.

d. Depreciation and Amortization Tables

Must be enclosed by all Taxpayers following the format of Special Attachments 1A/1B, except where the Taxpayer does not have and use tangible assets and or intangible assets/other expenditures that must be capitalized through depreciation/amortization;

e. Loss Carried Forward Table

Must be enclosed by Taxpayers who have the right to compensate loss incurred in the previous tax years, following the form of Special Attachments 2A/2B;

f. Investment Facilities Provided

Must be enclosed by Taxpayers who have been granted investment facilities, following the form of Special Attachments 4A/4B;

g. List of Major Branches

Must be enclosed by Taxpayers who have major branches or business places in different locations, following the form of Special Attachments 5A/5B;

h. Third copy of Payment Receipt of Income Tax Article 26 paragraph (4) (branch profit tax)

Must be enclosed by all Permanent Establishments (other than foreign shipping/aircraft companies and representative offices), except where there is no tax payable. In case the Taxpayers pay taxes through e-payment system to the registered banks, please enclose a valid tax payment receipt as a replacement for the third copy of Tax Payment Receipt;

i. Calculation of Income Tax Article 26 Paragraph (4):

Must be enclosed by all Permanent Establishment (though there is no tax payable), following the form of Special Attachments 6A/6B;

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j. Foreign Tax Credits

Must be enclosed by Taxpayers who derive income from overseas and such an income has been subjected to tax in the source country, following the form of Special Attachments 7A/7B;

k. Power of Attorney

Must be enclosed by Taxpayers who assign somebody else to fill out their Annual Income Tax Return.

l - Other Attachments List of Bad Debt Account, must be enclosed by Taxpayer which perform bad debt

account write-off. List of creditor which has credit classified as substandard, doubtful, and loss, must

be attached by Taxpayer in banking industries which reporting income from non-performing loan interest on cash basis.

Copy of Fiscal payment slip (TBPFLN), then should to filed by Taxpayer if there is Foreign Fiscal tax Credit.

Particularly for Contractor Production Sharing (Migas) should to file a Financial Quarterly Report for the last period in a year corcerned.

Other Attachments in the form of supported document or to describe the calculation of total income that made by Taxpayer himself.

Nominative List of promotion expenses, must be submitted by taxpayer who spend promotional cost.

Financial Statement component of business- sharia basis which is includes Sources Report and Zakat Utilizing and Sources and Fund Utilizing Report, shall be enclosed by Taxpayer which has principal business on sharia-basis.

DECLARATION:

Fill with the place where and date when the Annual Tax Return is completed along with full name, Taxpayer Identification Number (NPWP) and signed by authorized board of directors. In the case where the Annual Tax Return is completed by an authorised representative/proxy, fill the blank with full name, Taxpayer Identification Number (NPWP) and signed. Fill “X” in the appropriate box. Seal with company stamp.

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SPECIAL ATTACHMENTS TO THE ANNUAL TAX RETURN

1. CALCULATION OF DEPRECIATION AND AMORTIZATION FOR TAX PURPOSE(SPECIAL ATTACHMENT 1A/1B)

Fill with any type of tangible / intangible assets owned and used in the operation of the company which can be depreciated / amortized.

“NOTE” column shall be filled with any relevant information regarding:

=> Years of which assets revaluation have been undertaken

=> Investment facilities in form of accelerated depreciation / amortization

“DEPRECIATION / AMORTIZATION METHOD” column shall be filled with code as follow:

DEPRECIATION / AMORTIZATION METHOD CODE UTILIZATION

Straight Line GL Commercial / Fiscal

Sum of the Years Digit JAT Commercial

Declining Balance SM Commercial / Fiscal

Double Declining Balance SMG Commercial

Sum of Service Hours JJJ Commercial

Sum of Unit Production JSP Commercial / Fiscal

Other Methods ML Commercial For Taxpayers using United States currency in maintain book of account, provisions on conversion rate for fixed assets regulated by Minister of Finance Decree No. 196/PMK.03/2007 shall be taken into account.

See: Minister of Finance Regulation Number 96/PMK.03/2009; Minister of Finance Decree Number 521/KMK.04/2000; Director General of Taxes Decree Number KEP-220/PJ./2002; Director General of Taxes Deccre Number KEP-316/PJ./2002; Director General of Taxes Circular Number SE-07/PJ.42/2002; Director General of Taxes Circular Number. SE-09/PJ.42/2002;

2. CALCULATION OF LOSS CARRIED FORWARD (SPECIAL ATTACHMENT 2A/2B)

Computation of loss carried forward shall consist only of fiscal loss incurred from the business operation in Indonesia, shall not include fiscal loss incurred from business operation outside Indonesia either through Permanent Establishment or not. Based on Minister of Finance Decree Number 164/PMK.03/2002 jo. Director General of Taxes Circular Number SE-03/PJ.31/2004, fiscal loss incurred from business operation outside Indonesia shall only be compensated to the taxable income derived from the business operation outside Indonesia in the same country (per country basis). In that case, separated calculation of loss carried forward shall be made using the same format.

Column “LOSS AND NET TAXABLE INCOME” shall be filled with the amount taken from Notice of Tax Assessment or Objection Decision/Appeal Decision, or in the case where such decision has not been issued taken from Annual Tax Return.

Columns “LOSS CARRIED FORWARD” shall be filled with the amount of loss carried forward distributed from the amount for each year after the year in which such fiscal loss incurred. In

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case where investment facilities are granted in the form of loss carried forward for more than 5 years (fiscal loss incurred from investment since commercial production firstly started), the number of year and column may be added using the second sheet.

For Taxpayers using United States Dollar in the books of account, provisions regarding loss carried forward as regulated by Minister of Finance Decree Number 5196/PMK.03/2007 shall be taken into account.

Move the amount in the column (8) “THIS TAXABLE YEAR” to FORM 1771 or FORM 1771 / $ (Sub Paragraph A Point 2), and move the amount in the column (9) “CURRENT YEAR” to FORM 1771 or FORM 1771 / $ (Subparagraph E item 14 sub item b).

Example (Form of Special Attachment 2A):

PT ABC was established in 2002. In 2010, the Taxpayer derived taxable income at the amount of IDR 50.000.000,-. Previous years’ taxable incomes or fiscal losses are as follow:

Year 2002, fiscal loss IDR 20.000.000,- Year 2003, fiscal loss IDR 5.000.000,- Year 2004, fiscal loss IDR 1.000.000,- Year 2005, fiscal loss IDR 100.000.000,- Year 2006, fiscal loss IDR 20.000.000,- Year 2007, taxable income IDR 30.000.000,- Year 2008, taxable income IDR 10.000.000,- Year 2009, fiscal loss Rp 5.000.000,- Filling to the Special Form 2A is as the following:

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NO

LOSS AND NET TAXABLE INCOME LOSS CARRIED FORWARD

YEAR CURRENCY AMOUNT YEAR. 2006 US$/(IDR)

YEAR. 2007 US$/(IDR)



YEAR. 2010 HIS TAXABLE YEAR

US$/(IDR)* )

YEAR. 2011 (CURRENT YEAR)

US$/(IDR)**)

(1) (2) (3) (4) (5) (6) (7) (8) (9)

1 2002 (20.000.000,00) 0,00 20.000.000,00 0,00 0,00 --- ---

2 2003 (5.000.000,00) 0,00 5.000.000,00 0,00 0,00 --- ---

3 2004 (1.000.000,00) 0,00 1.000.000,00 0,00 0,00 --- ---

4 2005 (100.000.000,00) 0,00 4.000.000,00 10.000.000,00 0,00 50.000.000,00 ---

5 2006 (20.000.000,00) 0,00 --- 0,00 0,00 --- 20.000.000,00

6 2007 30.000.000,00 0,00 --- 0,00 0,00 --- ---

7 2008 10.000.000,00 0,00 --- 0,00 0,00 --- ---

8 2009 (5.000.000,00) 0,00 --- 0,00 0,00 --- 5.000.000,00

9 2010 50.000.000,00 0,00 --- 0,00 0,00 --- --- TOTAL : 0,00 30.000.000,00 10.000.000,00 0,00 50.000.000,00 25.000.000,00

ES :

COPY THE AMOUNT OF COLUMN (8)TO FORM 1771 PART A LINE 2

COPY THE AMOUNT OF THIS COLUMN TO FORM 1771 PART E LINE 14 SUBLINE b TAXPAYER / AUTHORISED REPRESENRTATIVES,

( …………..……………………. )

SPECIAL ATTACHMENT OF ANNUAL TAX RETURN CORPORATE INCOME TAX

TAXABLE YEAR

LOSS CARRIED FORWARD CALCULATION FOR TAX PURPOSE

FOR TAXABLE YEAR AND CURRENT TAXABLE YEAR

: NAME : PT ABC

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3. STATEMENT OF TRANSACTION IN RELATED PARTIES (SPECIAL ATTACHMENT 3A/3B; 3A-1/3B-1; and 3A-2/3B-2)

.Attachment 3A/3B is a tool for Taxpayer for reporting parties that have special relationship and transaction which performed with them.

Taxpayer who obliged to fill Attachment 3A/3B Taxpayer who obliged to fill attachment 3A/3B is any Taxpayer who have related parties and/or have a transaction with related parties.

Parties that have special relationship is a parties as regulated in : Article 18 paragraph (4) of Income Tax Law; Article 2 paragraph (2) of VAT Law; Article 9 paragraph (1) of Indonesia Double Taxation Treaty with partner agreement.

A. SPECIAL ATTACHMENT 3A/3B (STATEMENT OF TRANSACTION WITH RELATED

PARTIES) I. LIST OF RELATED PARTIES Fill with list of Related Parties .

1. Name Fill with a full name of Related Parties.

2. Address Fill with address of related parties .

3. Tax Identification Number Fill with TIN Related Parties from both resident and foreign Taxpayer. In term of affiliation Taxpayer is a foreign Taxpayer that don’t have taxpayer identification in their country, so that, in column of TIN can be given with “-“ mark, with statement of letter that should be attached when taxpayer submit the tax return

4. Business Activities Fill with a major activities which conducted by related parties in transaction with Taxpayer .

5. Types of relationship with Taxpayer Fill with select more than one form of relationship that have Taxpayer made with parties that have special relationship. The following form of those relationship are: a. Related Parties because of share ownership which is regulated in Article 18 paragraph

(4) subparagraph a Income Tax Law. b. Related Parties because of mastery/controlling which is regulated in Article 18 paragraph

(4) subparagraph b of Income Tax Law. c. Related Parties because of family relationship which is regulated in Article 18 paragraph

(4) subparagraph c Income Tax Law. d. Related parties because of controlling which is regulated in Tax Treaty Agreement Article

9 paragraph (1) between Indonesia and Taxpayer’s related parties domicile country.

II. DETAILS OF TRANSACTION WITH PARTIES THAT HAVE SPECIAL RELATIONSHIP (RELATED PARTIES)

1. Number of Sequence To be stated with number based on sequences transaction.

2. Name of Transaction Partner

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To be stated with the name of transaction partner with parties that have special relationship with Taxpayer as reported in table I.

3. Types of Transaction To be stated with: a. Selling/ purchasing of tangible goods (materials, finished goods and merchandises), b. Selling/purchasing of capital goods, included fixed assets, c. transfer/utilization of intangible assets, d. rental of money, e. transfer of services, f. transfer /obtaining of financial instrument such as shares and bonds, g. etc.

4. Transaction Value To be stated with the total of transaction value.

5. Method of Determination of Prices To be stated with selected method used for determine of reasonable transfer pricing in transaction with parties that have special relationship, as arranged by Income Tax Law. The following methods are: 1. Comparable Uncontrolled Price 2. Cost Plus Method 3. Resale Price Method 4. Transactional Net Margin Method 5. Profit Split Method

6. Reasons of using Methods To be stated with any reasons of why should the Taxpayer select for using one in these methods in calculate of transfer pricing.

B. SPECIAL ATTACHMENT 3A-1/3B-1 (STATEMENT OF TRANSACTION IN RELATED PARTIES) DOCUMENTATION REASONABLE PRICING Fill “ X” in the available box (Yes or not) of each statements, in accordance with condition of documentation owned by the Taxpayer. The Document as reffered in this special attachment of 3A-1/3B-1, should be adjusted with international prevalence in term of Taxpayer stated that they have the document. Taxpayer could determine types and form of transfer pricing document by their own which is adjusted with their business field, as long as the document supporting the utilize of determination method of fairly price that chosen by Taxpayer.

C. SPECIAL ATTACHMENT 3A-2/3B-2 (STATEMENT OF TRANSACTION WITH PARTIES THAT PART OF TAX HAVEN COUNTRY RESIDENT) Taxpayer who should fill this Attachment Taxpayer who should fill this attachment is a Taxpayer who had transaction with tax haven country resident I. IF A TAXPAYER IS MAKING TRANSACTION WITH PARTIES THAT ARE TAX HAVEN

COUNTRY IN THIS TAXABLE YEAR. To be stated with list of parties that are tax haven country resident whom have a transaction with Taxpayer.

1. Name To be stated with full name of parties that are tax haven country resident.

25

2. Types of Transaction To be stated with: a. selling/purchasing of tangible goods (materials, finished goods and merchadises), b. selling/pirchasing of capital goods, included fixed assets, c. transfer/utilization of intangible assets, d. rental of money, e. transfer of services, f. transfer/obtaining of financial instrument such as share and bonds, g. etc.

3. Country To be stated with countries of transaction partner that are tax haven in accordance with existing regulations.

4. Transactions Value To be stated with the total of transactions value.

II. DETERMINATION OF TRANSACTIONS VALUE ABOVE, STIPULATED BY USING THE

TERM ARM’S LENGTH OR ORDINARY BUSINESS PRINSIPAL Fill “yes” or “no” answer and fill “X” in the appropriate box, according to transaction condition and price determination that have made by Taxpayer.

4. LIST OF INVESTMENT FACILITIES (SPECIAL ATTACHMENT 4A/4B)

Point 1: a. Fill with Number / Date of the Approval Letter from the Investment Coordinating Board (BKPM).

b. Fill with Number / Date of Minister of Finance Decree on the granting of investment facilities.

Point 2: a. THE AMOUNT OF INVESTMENT APPROVED, fill with the amount of investment as approved by BKPM using currency as in the approval. If the currency differs from that of used by the company in the bookkeeping, please specify the equivalent amount using actual rate at the time when transfer was made to the company’s bank account. In case the transfer has not been made, the equivalent amount shall be calculated using the actual rate at the time when approval from BKPM was issued (make a footnote when necessary).

a. INVESTMENT, new or expansion, cross in the appropriate box based on the approval from BKPM;

b. FIELD OF INVESTMENT, fill with the business field approved for the investment based on the approval from BKPM;

c. FACILITIES GRANTED, cross in the appropriate box based on the type of facilities granted (and point 6 to 10 in the year box) based on the Minister of Finance Decree.

Point 3: INVESTMENT REALIZATION:

a. THIS YEAR, fill with the amount of investment realized in the tax year of the Annual Tax Return during the period until commercial production has been started.

26

b. UP TO THIS YEAR, fill with the cumulative amount of investment realized until the tax year of the Annual Tax Return during the period until commercial production has been started, based on investment realization report that has been audited by a public accountant.

Point 4: Fill with the date when commercial production was firstly made based on the investment realization report that has been audited by a public accountant.

Point 5: NET INCOME REDUCTION FACILITY,

fill in the year box with number 1 to 6 consecutively for each tax year since the year when commercial production has been started, and the amount of net income deduction facility for such a year which is calculated by multiplying 5% from the amount of investment realization as stated in Point 3 Item b above. Move the amount calculated in Point 5 to FORM 1771 – I or FORM 1771 – I / $ (Line 7 Column 3).

See: Government Regulation Number 1 of 2007 as lastly amended by Government Regulation No. 62

year 2008; Minister of Finance Regulation Number 16/PMK.03/2007; Director General of Taxes Regulation Number PER-67/PJ./2007.

5. LIST OF MAJOR BRANCHES (SPECIAL ATTACHMENT 5A/5B)

Fill only with information of complete address and TIN (if has been registered in tax service office – location), of the main branches or places of business. For minor branches or representative offices under such major branches, please specify only the number. Foreign branches or representative offices shall also be disclosed.

- Column (1) filled with Numbers in sequence - Column (2) filled with major branch address - Column (3) filled with TIN of location - Column (4) filled with amount of sub-Branches

6. CALCULATION OF INCOME TAX ARTICLE 26 PARAGRAPH (4) (SPECIAL ATTACHMENT 6A/6B)

Point 1: COMMERCIAL NET INCOME,

fill with the amount taken from FORM 1771 – I or 1771 – I / $ (line 3 column (3))

Point 2: TAX ADJUSTMENT,

fill with the amount taken from FORM 1771 – I or FORM 1771 – I / $ (Amount Point 5m and Point 6e). In case the Taxpayer / Permanent Establishment is subject to Finalized Tax, positive / negative tax adjustment shall be computed separately in accordance with the bookkeeping / financial statements.

Point 3: FISCAL NET INCOME

if the amount is negative then it is not necessary to make further filling because Income Tax Article 26 Paragraph (4) will not be payable.

Point 4: TAX DUE,

fill with the amount taken from FORM 1771 or FORM 1771 / $ (Sub Paragraph B Point 6), or in case subjected to Finalized Tax, fill with the amount taken from FORM 1771 – IV or FORM 1771 – IV / $ (Part A Point 7 or 8).

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Point 5: TAX BASE FOR BRANCH PROFIT TAX CALCULATION,

if the amount is negative then it is not necessary to make further filling because Income Tax Article 26 Paragraph (4) will not be payable.

Point 6: BRANCH PROFIT TAX,

if any, fill “X” in the appropriate box and provide necessary information in the blank next to the box.

See : Ministry of Finance Regulation Number 257/PMK.03/2008

7. FOREIGN TAX CREDITS (SPECIAL ATTACHMENT 7A/7B)

Fill with the detail of withholding tax receipt / income payment receipt payable in the country outside Indonesia with supported by financial statement of income from foreign country, copy of Annual Tax Return which is applied in foreign country and copy of tax payment document in foreign country. The calculation method should to refer on Article 24 of Income Tax Law jo. Ministry of Finance Decree Number 164/KMK.03/2002, dated 19 April 2002.

The amount of income tax payable or has been paid outside Indonesia that can be credited shall not exceed the amount that is calculated using the following formula.

The amount of Income derived from outside Indonesia ---------------------------------------------------------------------------------------------------------- X Total Income Tax Payable

Taxable Income or the same as Total Income Tax Payable, whichever is smaller

In case where foreign income is received/derived from several countries, tax credit shall be computed using the above formula for each of the country (ordinary credit per country basis). Taxable Income on that formula not including subject to finalized tax as ammended in Article 4 paragraph (2), Article 8 paragraph (1) and paragraph 4 Income Tax Law.

See: Minister of Finance Decree Number 164/KMK.03/2002

- Column (1), fill with Numbers in sequence

- Column (2), fill with Name of Withholding Agent Overseas

- Column (3), fill with Address of Withholding Agent Overseas

- Column (4), fill with Type of Income

- Column (5), fill with the Amount of Net Income Received

- Column (6), fill with the amount of tax payable/paid outside Indonesia in Rupiah currency calculated using conversion rate at the time when the tax is paid or payable.

- Column (7), fill with the amount of tax payable/paid outside Indonesia in foreign currency.

- Column (8), fill with the amount of calculated tax credit according to provision of Article 24 Income Tax Law, Ministry of Finance Number 164/KMK.03//2002.

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8. FINANCIAL STATEMENT OF ELEMENTS CITATION TRANSCRIPT (SPECIAL ATTACHMENT 8A-1 / 8A-2 / 8A-3 / 8A-4 / 8A-5 / 8A-6 / 8B-1 / 8B-2 / 8B-3 / 8B-4 / 8B-5 / 8B-6/ 8B-7 / 8B-8)

Financial Statement of Elements Citation Transcript is summary of financial statement which show all the content of financial statement. Financial Statement Citation Transcript differentiate according to Taxpayer’s business types, that is:

No. Form Code Types of Business

1. 8A-1 8B-1 Industrial Companies

2. 8A-2 8B-2 Trading Companies

3. 8A-3 8B-3 Conventional Banks

4. 8A-4 8B-4 Sharia Banks

5. 8A-5 8B-5 Insurance Companies

6. 8A-6 8B-6 Non-Qualification (except those five business types)

7. 8A-7 8B-7 Pension Fund

8. 8A-8 8B-8 Finance Companies

Form Code which contain of “A” , is form code for Taxpayer who maintain bookkeeping in rupiahs currency, whereas Form Code which contain of “B”, is Form Code for Taxpayer who permitted to maintain bookkeeping in United State Currency.

Every Taxpayer should to fill one of those Financial Statement of Element Citation Transcrip according to their business types.

INSTRUCTION OF COMPLETION

Taxable Year : filed with a number yearbook and a period yearbook of companies. TIN : filed with TIN as stated in TIN card Taxpayer’s Name : filed with Names as stated on TIN card Elements of Balace Sheet Element of balance sheet consist of two sides, asset’s, liability and equity’s side. Each balance account in financial statement should be moved properly in to balance sheet

account within the transcript Taxpayer files Balance account within citation transcript as needed according to the account

within financial statement. If balance sheet account is not existing within financial statement, the column of those within

citation transcript is sufficiently filled with minus (-) sign. If balance sheet account in financial statement is not appropriate within citation transcript, those

account value of financial statement shall be moved in to similar account or any other account within citation transcript, for example goodwill account moves in to other non current asset account.

Elements of Income Statement Each account balance of income statement within financial statement shall be properly moved in

to income statement account within citation transcript. Taxpayer files income statement account within citation transcript as needed according to

account in financial statement. If income statement account in citation transcript is not existing within financial statement, the

column of those citation transcript is sufficiently filled with minus (-) sign.

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If Income Statement account in financial statement is not appropriate within citation transcript, those account value of income statement shall be moved in to similar account or any other account within citation transcript.

Elements of Transaction with parties that have special relationship in accordance with PSAK No.7 Parties that have special relationship is a parties that perceived having the capability of

controlling other parties or having significant influences of taking financial and operational decision.

The transaction between parties that have special relationship is a transfer of sources or obligation between parties that have special relationship, without recking of whether the price is calculated.

The following belows are an example of transaction between parties that have special relationship that probably needs some disclosure: - Selling or purchasing goods - Selling or purchasing of property and other assets - Furnishing or receiving services - Transfer of research and development - fund (including loan and deposits of capital both in cash and benefit in kind ) - guarantee and collateral - contract of management

Statement a. to be stated with date and place when the transcript was made b. fill “X” in the appropriate box c. to be stated with full name management/representative d. box to be stated with signature and company’s seal

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1A

FOR TAXABLE YEAR 2 0

T I N : TAXPAYER'S NAME :

TANGIBLE ASSETS Group 1 : …………………………………………………. Group 2 : …………………………………………………. Group 3 : …………………………………………………. Group 4 : …………………………………………………. BUILDINGS Permanent …………………………………………………. Not Permanent : ………………………………………………….

TOTAL DEPRECIATION (For Tax purpose)……………..……………..……………..……………..……………..……………..……………..……………..……………..……………..…………………………………..…Ø TOTAL COMMERCIAL DEPRECIATION ……………..……………..……………..……………..……………..……………..……………..……………..……………..………………….………………………….……… Ø DIFFERENCE ( COPY TO FORM 1771-I LINE 5 LETTER i OR LINE 6 LETTER a) ……………..……………..……………..……………..……………….………………………..……………………….. Ø INTANGIBLE ASSETS Group 1 : …………………………………………………. Group 2 : …………………………………………………. Group 3 : …………………………………………………. Group 4 : …………………………………………………. Other Group ………………………………………………….

TOTAL AMORTIZATION (For Tax purpose)……………..……………..……………..……………..……………..……………..……………..……………..………………………………...…..……………..…………… R TOTAL COMMERCIAL AMORTIZATION ……………..……………..……………..……………..……………..……………..……………..……………..……………………….………………...……………..………… Ø DIFFERENCE ( COPY TO FORM 1771-I LINE 5 LETTER j OR LINE 6 LETTER b) …………..…...……………..……………..……………..…………………………………………………. Ø

…………………………...…,

TAXPAYER/AUTHORIZED REPRESENTATIVE

(……………………………………………………………)

NOTEYEAR OF(IDR) (IDR) COMMERCIAL VALUEACQUISITION FISCAL (IDR)

SPECIAL ATTACHMENT ANNUAL INCOME TAX RETURN FOR CORPORATE

LIST OF DEPRECIATION AND AMORTIZATION FISCAL

GROUP / TYPES OF ASSETSMONTH/

COST OF ACQUISITIONDEPRECIATION/ AMORTIZATION

METHODFISCAL DEPRECIATION/AMORTIZATION

IN CURRENT YEARBEGINNING BALANCE

31

1B



TANGIBLE ASSETS Group 1 : …………………………………………………. Group 2 : …………………………………………………. Group 3 : …………………………………………………. Group 4 : …………………………………………………. BUILDINGS Permanent …………………………………………………. Not Permanent : ………………………………………………….

TOTAL DEPRECIATION (For Tax purpose)……………..……………..……………..……………..……………..……………..……………..……………..……………..……………..…………………………………..…Ø TOTAL COMMERCIAL DEPRECIATION ……………..……………..……………..……………..……………..……………..……………..……………..……………..………………….………………………….……… Ø DIFFERENCE ( COPY TO FORM 1771-I LINE 5 LETTER i OR LINE 6 LETTER a) ……………..……………..……………..……………..……………….………………………..……………………….. Ø INTANGIBLE ASSETS Group 1 : …………………………………………………. Group 2 : …………………………………………………. Group 3 : …………………………………………………. Group 4 : …………………………………………………. Other Group ………………………………………………….

TOTAL AMORTIZATION (For Tax purpose)……………..……………..……………..……………..……………..……………..……………..……………..………………………………...…..……………..…………… R TOTAL COMMERCIAL AMORTIZATION ……………..……………..……………..……………..……………..……………..……………..……………..……………………….………………...……………..………… Ø DIFFERENCE ( COPY TO FORM 1771-I LINE 5 LETTER j OR LINE 6 LETTER b) …………..…...……………..……………..……………..…………………………………………………. Ø

…………………………...…,


(……………………………………………………………)

FOR CORPORATION PERMITTED TO MAINTAIN BOOKS OF ACCOUNT IN ENGLISH LANGUAGE AND US DOLLAR CURRENCY

NOTEYEAR OFACQUISITION (US$) (US$) COMMERCIAL VALUE FISCAL (US$)



GROUP / TYPES OF ASSETSMONTH/

COST OF ACQUISITION BEGINNING BALANCEDEPRECIATION/ AMORTIZATION

METHODFISCAL DEPRECIATION/AMORTIZATION

IN CURRENT YEAR

32

2A

TAXABLE YEAR 2 0


T I N : TAXPAYER'S NAME

YEAR. YEAR. YEAR. YEAR. YEAR. YEAR.

(1)

1

2

3

4

5 etc

NOTE: …………………………...…,

*) COPY THE AMOUNT OF THIS COLUMN TO FORM 1771 LETTER A LINE 2

**) COPY THE AMOUNT OF THIS COLUMN TO FORM 1771 LETTER E LINE 14 POINT b TAXPAYER / AUTHORIZED REPRESENTATIVE

(……………………………………………………………)

TTLTOTAL

(8) (9)(2) (3) (4) (5) (6) (7)

(CURRENT TAXABLE YEAR)

(IDR) (IDR) (IDR) (IDR) IDR *) IDR **)


CALCULATION OF FISCAL LOSS CARRY FORWARD

NO

LOSS AND FISCAL NET INCOME FISCAL LOSS CARRY FORWARD

YEAR IDR(THIS TAXABLE YEAR)

33

2B

TAXABLE YEAR 2 0




(1)

1

2

3

4

5 etc

NOTE: …………………………...…,



(……………………………………………………………)


TOTAL TTL

(8) (9)(2) (3) (4) (5) (6) (7)

(CURRENT TAXABLE YEAR)

(IDR) (IDR) (IDR) (IDR) IDR *) IDR **)



NO


YEAR IDR(THIS TAXABLE YEAR)

34

3A

FOR TAXABLE YEAR

T I N:

TAXPAYER'S NAME :

I LIST OF RELATED PARTIES

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

II DETAILS OF TRANSACTION WITH RELATED PARTIES

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

………………………,


IF NEEDED, ADDITIONAL PAGES MAY BE ADDED

(……………………………………………………………)

Determination of Price Method shall be used

Determination of MethodsTypes of Transaction Transaction's Value

STATEMENT OF TRANSACTION WITH RELATED PARTIES

Address Tax Identification Number (TIN) Business Activities

ANNUAL INCOME TAX RETURN FOR CORPORATE SPECIAL ATTACHMENT

NameNo.

Name No.

Types of Relationship with Taxpayer

35

3B

FOR TAXABLE YEAR

T I N:

TAXPAYER'S NAME :


1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4


a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

………………………,



(……………………………………………………………)


Determination of Price Method shall be used

Determination of MethodsNo. Name Types of Transaction Transaction's Value


No. Name Address Tax Identification Number (TIN) Business Activities Types of Relationship with Taxpayer


36

3A-1

FOR TAXABLE YEAR

T I N :

TAXPAYER'S NAME/PERMANENT ESTABLISHMENT :

Yes

Concerning of Transaction

Yes

Transaction with related parties

Yes

Taxpayer business strategy at the time when carry out the affiliation transaction

Yes

…………………….., …………………………………


____________________________________________

3

That we have made note about :

No

4 Concerning of determination of Fair Price

Functional analysis which is the primary consideration of tax payers' transactions with related parties companies, all risks assumed and assets are being used in those transactions.

The economic conditions when the transactions is happened.

Terms of transactions, including agreement between Taxpayers with related parties from foreign countries

Taxpayer's transaction with company which is not influenced by related parties or information about comparing transaction.

No

Operating aspects of Taxpayers business operations including details of functions which is delivered by units in the Taxpayers organization.

Description of Business Environment in detail.

2That we have made note about :


Ownership structure that refer to the dependability between all company in one group of multinational company.

The application of the determination methodology of transfer price and the use of comparing data in the determination of transfer price.

Concerning of Comparation Analysis Result Notes

Characteristic of product (goods, service, loans, finance instrument, etc) which has been transacted.


No

Methodology of price determination which applicable by Taxpayer, which shows how the fair price is acquired, and the reasons why this method is chosen, compared to other methods.

Comparing data used by the Taxpayer to determine of transfer price.

Corcerning of company's description in detail

In case of tax payers act as the selling, rendering, or borrowing party as mentioned on the above transactions, we have conducted records as follows :

- Pricing Policy and price list for the last 5 (five) years.

- Details of manufacturing cost or acquisition cost or service preparation cost.

SPECIAL ATTACHMENT

ANNUAL INCOME TAX RETURN FOR CORPORATE

STATEMENT OF TRANSACTION IN RELATED PARTIES

Organizational structure of Taxpayer Company.

No

These are some particular notes that we made to support the fact that transactions that have been made with related parties are in accordance with the arm's length principle and the common practice.

1

I DOCUMENTATION OF ARM'S LENGTH TRANSACTION DETERMINATION

37

3B-1

FOR TAXABLE YEAR

T I N :


Yes


Yes


Yes


Yes

…………………….., …………………………………


____________________________________________


No














3 Concerning of Comparation Analysis Result NotesThat we have made note about :

No




No

No




1 Corcerning of company's description in detailThat we have made note about :



SPECIAL ATTACHMENT


38

3A-2

FOR TAXABLE YEAR

TIN:

TAXPAYER'S NAME :

I

No

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

II DETERMINATION OF TRANSACTION'S VALUE ABOVE , SHALL BE REFERRED TO THE TERM ARMS LENGTH AND ORDINARY BUSINESS PRINCIPLE

YES NO

……………………….., ………………………TAXPAYER/AUTHORIZED REPRESENTATIVE

( ………………………… )



STATEMENT OF TRANSACTION WITH PARTIES OF TAX HAVEN COUNTRY RESIDENT

5

4

3

2

1

IN CASE OF THE COMPANY HAS MADE TRANSACTIONS WITH PARTIES OF TAX HAVEN COUNTRY RESIDENT IN THIS TAXABLE YEAR

Name of Transaction Colleagues Types of Transaction Country Transaction Value

SPECIAL ATTACHMENT

39

3B-2

FOR TAXABLE YEAR

TIN:

TAXPAYER'S NAME :

I

No

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g


YES NO

……………………….., ………………………TAXPAYER/AUTHORIZED REPRESENTATIVE

( ………………………… )



5

4

3

2

1




SPECIAL ATTACHMENT


40

4A

FOR TAXABLE YEAR

T I N :

TAXPAYER'S NAME :

IN CASE OF THE COMPANY HAS BEEN GRANTED TAX FACILITIES ON INVESTMENT, PLEASE EXPLAIN:

a. LETTER OF APPROVAL FROM BKPM b. LETTER OF MINISTER OF FINANCE DECREE

1 NUMBER : ……………………………………………………….. 1 NUMBER : ………………………………………………………..

2 DATE : ……………………………………………………….. 2 DATE : ………………………………………………………..

a. AMOUNT OF INVESTMENT APPROVED: 1. IN FOREX : 2a1

2. EQUIVALENT IDR. : 2a2 *)

3. IN IDR. : 2a3

4. TOTAL IDR. : 2a4

b. INVESTMENT : 1 NEW 2 EXPANSION

c. …………………………………………………………………………………………………………………………

d. FACILITIES GRANTED : 1 INVESTMENT ALLOWANCE

2 ACCELERATED DEPRECIATION/AMORTIZATION

3 LOSS CARRIED FORWARD 4 YEAR

INVESTMENT REALIZATION

a. THIS YEAR : IDR a

b. UP TO THIS YEAR : IDR b

FACILITIES OF INVESTMENT ALLOWANCE : YEAR a b IDR. **)

(5% X REALIZATION OF INVESTMENT UP TO CPS)

NOTE:

*) ……………………………,

**) COPY THE AMOUNT IN LINE 5 b TO FORM 1771-I TAXPAYER/AUTHORIZED REPRESENTATIVE

LINE 7 COLUMN (3)

5.

(……………………………………………………………)

4. TIME WHEN COMMERCIAL PRODUCTION STARTED (CPS), DATE:

PLEASE USE ACTUAL CONVERTION RATE AT THE TIME OF TRANSFER TO THE COMPANY'S ACCOUNT

5

3.

10 % TAX ON DIVIDENDS PAID TO FOREIGN SHAREHOLDERS

FIELD AND/OR REGION OF INVESTMENT:

1.

2.


2 0LIST OF INVESTMENT FACILITIES

41

4B

FOR TAXABLE YEAR

T I N :

TAXPAYER'S NAME :



1 NUMBER : ……………………………………………………….. 1 NUMBER : ………………………………………………………..

2 DATE : ……………………………………………………….. 2 DATE : ………………………………………………………..



3. IN US$. : 2a3

4. TOTAL US$. : 2a4


c. …………………………………………………………………………………………………………………………





a. THIS YEAR : US$. a

b. UP TO THIS YEAR : US$. b

FACILITIES OF INVESTMENT ALLOWANCE : YEAR a b US$. **)


NOTE:

*) ……………………………,


LINE 7 COLUMN (3)

5.


(……………………………………………………………)


3.



5 10 % TAX ON DIVIDENDS PAID TO FOREIGN SHAREHOLDERS

1.

2.



42

5A

FOR TAXABLE YEAR

T I N :

TAXPAYER'S NAME :

NOTE: ……………………………,


TAXPAYER /AUTHORIZED REPRESENTATIVE

etc.

(……………………………………………………………)

24

25

22

23

20

21

18

19

16

17

14

15

12

13

10

11

8

9

6

7

4

5

2

3

(1) (2) (3) (4)

1

NO ADDRESS OF MAIN BRANCHES OFFICE TIN LOCATIONNUMBER OF MAIN

BRANCHES


2 0LIST OF BRANCH MAJOR

43

5B

FOR TAXABLE YEAR

T I N :

TAXPAYER'S NAME :

NOTE: ……………………………,



25

etc.

(……………………………………………………………)

23

24

21

22

19

20

17

18

15

16

13

14

11

12

9

10

7

8

5

6

3

4

1

2


BRANCHES

(1) (2) (3) (4)




44

6A

FOR TAXABLE YEAR

T I N :

:

COMMERCIAL NET INCOME : ……………………………………………………… (BASED ON FINANCIAL STATEMENT)

FISCAL ADJUSTMENTS :

a. POSITIVE : IDR.

b. NEGATIVE : IDR.

c. TOTAL (a – b) : …………………………………………………………………

FISCAL NET INCOME : (1 +/- 2c) ……………………………………………………

CORPORATE INCOME TAX PAYABLE: ……………………………………………….

TAX BASE FOR INCOME TAX ART. 26 PARAGRAPH (4) : (3 - 4) ……………………………………

INCOME TAX ARTICLE 26 PARAGRAPH (4) :

a PAYABLE : …… *) % X AMOUNT IN LINE 5 ………………………………………

b NOT PAYABLE, BECAUSE:

c PROVISIONS OF TAX TREATY INDONESIA - …………………………

d REINVESTED WHOLLY IN INDONESIA IN A NEW LIMITED COMPANY: **)

………………………………………………………………………………………

TIN : e

ADDRESS : f ………………………………………………………………………………………

………………………………………………………………………………………

g CITY : …………………………………… POSTAL CODE : h

NOTE: ……………………,

*) TAX RATE OF 20% RATE STIPULATED IN TAX TREATY

**) PLEASE ATTACH THE DOCUMENTATION OF REINVESTMENT TAXPAYER/AUTHORIZED REPRESENTATIVE

TAXPAYER'S NAME/PERMANENT ESTABLISHMENT

SPECIAL ATTACHMENTANNUAL INCOME TAX RETURN FOR CORPORATE

2 0CALCULATION OF INCOME TAX ARTICLE 26 PARAGRAPH (4)

IDR

1.

2.

3.

4.

(……………………………………………………………)

5.

6.

45

6B

FOR TAXABLE YEAR

T I N :

:



a. POSITIVE : US$.

b. NEGATIVE : US$.

c. TOTAL (a – b) : …………………………………………………………………









………………………………………………………………………………………

TIN : e

ADDRESS : f ………………………………………………………………………………………

………………………………………………………………………………………


NOTE: ……………………,



(……………………………………………………………)


4.

5.

6.

3.

IDR

1.

2.




46

7A


NOTES : ……………………,

• PLEASE FILL WITH THE DETAIL OF EACH WITHHOLDING RECEIPT/TAX PAYMENT.

• TAXPAYER / AUTHORIZED REPRESENTATIVE

• TAX CREDIT THAT CAN BE CREDITED IN COLUMN (8) SHALL BE CALCULATED BY ORDINARY CREDIT PER COUNTRY BASIS METHOD

• COPY THE TOTAL AMOUNT IN COLUMN (8) TO FORM 1771 LETTER C LINE 8.b.

• COPY THE TOTAL AMOUNT IN COLUMN (5) TO FORM 1771-I line 2.

• IF NEEDED, ADDITIONAL PAGES MAY BE ADDED

(……………………………………………………………)


FOREIGN TAX CREDIT

TAX CREDITABLE

COLUMN (6) IDR FILL WITH CONVERTION VALUE FROM THE NUMBER IN COLUMN (7) FOREIGN EXCHANGE USING EXCHANGE RATE PREVAILING AT THE TIME OF TAX PAYMENT/TAX DUE IN FOREIGN COUNTRY

TOTAL TTL

10.

9.

8.

7.

6.

5.

4.

3.

2.

(7) (8)

1,

(1) (2) (3) (4) (5) (6)

IN FOREIGN COUNTRY

NAME ADDRESS(IDR)

IDR FOREIGN EXCHANGE (IDR)

NO.

WITHHOLDING AGENT

TYPES OF INCOMENET AMOUNT

TAX DUE / PAID

SPECIAL ATTACHMENT

TAXABLE YEAR

2 0

47

7B

TAXABLE YEAR

T I N : TAXPAYERS NAME :

NOTE ……………………,

• PLEASE FILL WITH THE DETAIL OF EACH WITHHOLDING TAX RECEPIT/TAX PAYMENT. WAJIB PAJAK / KUASA

• COLUMN (5) IDR, FILL WITH CONVERSION VALUE FORM COLUMN (6) FOREX, USING EXCHANGE RATE PREVAILING AT THE TIME OF TAX

PAYMENT/DUE IN FOREIGN (SOURCE) COUNTRY.

• TAX CREDIT THAT CAN BE CREDITED IN COLUMN (7) SHALL BE CALCULATED USING ORDINARY CREDIT PER COUNTRY BASIS METHOD

• PLEASE COPY THE TOTAL AMOUNT OF COLUMN (7) TO FORM 1771 ITEM C NUMBER 8.b

• PLEASE COPY THE TOTAL AMOUNT OF COLUMN (4) TO FORM 1771-I NUMBER 2.

• THIS FORM MAY BE COPIED IF NEED

2 0

etc

10

7

6

9

8

3

2

5

4

(5) (6)

1

(1) (2) (3) (4)

NET AMOUNT TAX PAID

US$ FOREX

(……………………………………………………………)

FOREIGN WITHHOLDING AGENT

SPECIAL ATTACHMENTANNUAL CORPORATE INCOME TAX RETURN

FOREIGN TAX CREDITS

FOR TAXPAYERS WHO ARE PERMITTED TO MAINTAIN BOOKEEPING

IN THE UNITED STATES DOLLAR CURRENCY

NO.

TTLT O T A L

(7)

TAX

NAME AND ADDRESS OF TYPE OF INCOME (US$) OUTSIDE INDONESIA CREDITABLE

(US$)

48

LIST OF TAXES REGULATION

No. Regulatins Number Date Concerning

1. Undang-Undang 28 17/07/2007 Perubahan Ketiga atas atas Undang-Undang Nomor 6 Tahun 1983 tentang Ketentuan Umum dan Tata Cara Perpajakan

2. Undang-Undang 16 25/03/2009 Penetapan Peraturan Pemerintah Pengganti Undang-Undang Nomor 5 Tahun 2008 tentang Perubahan Keempat atas Undang-Undang Nomor 6 Tahun 1983 tentang Ketentuan Umum dan Tata Cara Perpajakan

3. Undang-Undang 36 23/09/2008 Perubahan Keempat atas Undang-Undang Nomor 7 Tahun 1983 tentang Pajak Penghasilan

4. Peraturan Pemerintah

80 28/12/2007 Tata Cara Pelaksanaan Hak dan Kewajiban Perpajakan Berdasarkan Undang-Undang Nomor 6 Tahun 1983 tentang tentang Ketentuan Umum dan Tata Cara Perpajakan sebagaimana telah Beberapa Kali Diubah Terakhir dengan Undang-Undang Nomor 28 Tahun 2007


138 21/12/2000 Penghitungan Penghasilan Kena Pajak Dan Pelunasan Pajak Penghasilan Dalam Tahun Berjalan


25 18/05/2001 Perubahan Ketiga atas Peraturan Pemerintah Nomor 42 Tahun 1995 tentang Bea Masuk, Bea Masuk Tambahan, Pajak Pertambahan Nilai Dan Pajak Penjualan Atas Barang Mewah Dan Pajak Penghasilan Dalam Rangka Pelaksanaan Proyek Pemerintah Yang Dibiayai Dengan Hibah Atau Dana Pinjaman Luar Negeri


81 28/12/2007 Penurunan Tarif Pajak Penghasilan bagi Wajib Pajak Badan Dalam Negeri yang Berbentuk Perseroan Terbuka


51 20/07/2008 PPh atas Penghasilan dari Usaha Jasa Konstruksi


62 23/09/2008 Perubahan atas Peraturan Pemerintah Nomor 1 Tahun 2007 tentang Fasilitas Pajak Penghasilan Untuk Penanaman Modal Di Bidang-Bidang Usaha Tertentu Dan/Atau Di Daerah-Daerah Tertentu

10. Peraturan Menteri Keuangan

16/PMK.03/2007 19/02/2007 Pemberian Fasilitas Pajak Penghasilan Untuk Penanaman Modal Di Bidang-Bidang Usaha Tertentu dan/atau di Daerah-DaerahTertentu


181/PMK.03/2007 28/12/2007 Bentuk dan Isi Surat Pemberitahuan serta Tata Cara Pengambilan, Pengisian, dan Penandatanganan dan Penyampaian Surat Pemberitahuan


152/PMK.03/2009 29/09/2009 Perubahan atas Peraturan Menteri Keuangan Nomor 181/PMK.03/2007 Tentang Bentuk dan Isi Surat Pemberitahuan serta Tata Cara

49


Pengambilan, Pengisian, dan Penandatanganan dan Penyampaian Surat Pemberitahuan


192/PMK.03/2007 28/12/2007 Tata Cara Penetapan Wajib Pajak Dengan Kriteria Tertentu Dalam Rangka Pengembalian Pendahuluan Kelebihan Pembayaran Pajak


193/PMK.03/2007 28/12/2007 Batasan Jumlah Peredaran Usaha, Jumlah Penyerahan, dan Jumlah Lebih Bayar bagi Wajib Pajak yang Memenuhi Persyaratan Tertentu yang Dapat Diberikan Pengembalian Pendahuluan Kelebihan Pajak


54/PMK.03/2009 27/03/2009 Perubahan atas Peraturan Menteri Keuangan Nomor 193/PMK.03/2007 tentang Batasan Jumlah Peredaran Usaha, Jumlah Penyerahan, dan Jumlah Lebih Bayar bagi Wajib Pajak yang Memenuhi Persyaratan Tertentu yang Dapat Diberikan Pengembalian Pendahuluan Kelebihan Pajak


196/PMK.03/2007 28/12/2007 Tata Cara Penyelenggaraan Pembukuan Dengan Menggunakan Bahasa Asing Dan Satuan Mata Uang Selain Rupiah Serta Kewajiban Penyampaian Surat Pemberitahuan Tahunan Pajak Penghasilan Wajib Pajak Badan


187/PMK.03/2008 20/11/2008 Tata Cara Pemotongan, Penyetoran, Pelaporan, dan Penatausahaan PPh atas Penghasilan dari Usaha Jasa Konstruksi


255/PMK.03/2008 21/12/2008 Penghitungan Besarnya Angsuran Pajak Penghasilan Dalam Tahun Pajak Berjalan Yang Harus Dibayar Sendiri Oleh Wajib Pajak Baru, Bank, Sewa Guna Usaha Dengan Hak Opsi, Badan Usaha Milik Negara, Badan Usaha Milik Daerah, Wajib Pajak Masuk Bursa Dan Wajib Pajak Lainnya Yang Berdasarkan Ketentuan Diharuskan Membuat Laporan Keuangan Berkala Termasuk Wajib Pajak Orang Pribadi Pengusaha Tertentu

50



208/PMK.03/2009 10/12/2009 Perubahan atas Peraturan Menteri Keuangan Nomor 255/PMK.03/2008 tentang Penghitungan Besarnya Angsuran Pajak Penghasilan dalam Tahun Pajak Berjalan yang harus Dibayar Sendiri oleh Wajib Pajak Baru, Bank, Sewa Guna Usaha dengan Hak Opsi, Badan Usaha Milik Negara, Badan Usaha Milik Daerah, Wajib Pajak Masuk Bursa dan Wajib Pajak lainnya yang Berdasarkan Ketentuan Diharuskan membuat laporan Keuangan Berkala Termasuk Wajib Pajak Orang Pribadi Pengusaha Tertentu


257/PMK.03/2008 31/12/2008 Perlakuan Perpajakan Atas Penghasilan Kena Pajak Sesudah Dikurangi Pajak Dari Suatu Bentuk Usaha Tetap


81/PMK.03/2009 22/04/2009 Pembentukan Atau Pemupukan Dana Cadangan Yang Boleh Dikurangkan Sebagai Biaya


83/PMK.03/2009 22/04/2009 Penyediaan Makanan dan Minuman bagi Seluruh Pegawai serta Penggantian atau Imbalan dalam Bentuk Natura dan Kenikmatan di Daerah Tertentu dan Yang Berkaitan dengan Pelaksanaan Pekerjaan yang Dapat Dikurangkan dari Penghasilan Brito Pemberi Kerja


96/PMK.03/2009 15/05/2009 Jenis-Jenis Harta yang Termasuk dalam Kelompok Harta Berwujud Bukan Bangunan untuk Keperluan Penyusutan


153/PMK.03/2009 29/09/2009 Perubahan atas Peraturan Menteri Keuangan Nomor 187/PMK.03/2008 Tentang Tata Cara Pemotongan, Penyetoran, Pelaporan, dan Penatausahaan PPh atas Penghasilan dari Usaha Jasa Konstruksi

25. Keputusan Menteri Keuangan

604/KMK.04/1994 21/12/1994 Badan-Badan dan Pengusaha Kecil yang Menerima Harta Hibahan yang Tidak Termasuk sebagai Objek PPh


521/KMK.04/2000 14/12/2000 Jenis-Jenis Harta Yang Termasuk Dalam Kelompok Harta Berwujud untuk Keperluan Penyusutan Bagi Kontraktor Yang Melakukan Eksplorasi dan Eksploitasi Minyak Dan Gas Bumi Dalam Rangka Kontrak Bagi Hasil dengan Perusahaan Pertambangan Minyak Dan Gas Bumi Negara (Pertamina)


534/KMK.04/2000 22/12/2000 Bentuk dan Isi Surat Pemberitahuan serta Surat Keterangan dan/atau Dokumen yang Harus Dilampirkan


164/KMK.03/2002 19/04/2002 Kredit Pajak Luar Negeri

51


29. Peraturan Dirjen Pajak

PER-67/PJ./2007 05/04/2007 Tata Cara Pemberian Fasilitas Pajak Penghasilan Untuk Penanaman Modal Di Bidang-Bidang Usaha Tertentu dan/atau di Daerah-Daerah Tertentu

30. Peraturan Dirjen Pajak

PER-38/PJ/2008 24/09/2008 Tata Cara Pemberian Angsuran atau Penundaan Pembayaran Pajak

31. Keputusan Dirjen Pajak

KEP-141/PJ./1999 21/06/1999 Pengakuan Penghasilan Dari Pengalihan Harta/Agunan Berupa Tanah Dan/Atau Bangunan Bagi Wajib Pajak Tertentu


KEP-214/PJ./2001 15/03/2001 Keterangan dan/atau Dokumen yang Harus Dilampirkan dalam Surat Pemberitahuan


KEP-563/PJ./2001 08/08/2001 Saat Pengakuan Penghasilan Berupa Keuntungan Karena Pembebasan Utang Yang Diperoleh Debitur Tertentu Dari Perjanjian Restrukturisasi Utang Usaha


KEP-184/PJ./2002 11/04/2002 Pengakuan Penghasilan Atas Penghasilan Bank Berupa Bunga Kredit Non Performing


KEP-220/PJ./2002 18/04/2002 Perlakuan Pajak Penghasilan atas Biaya Pemakaian Telepon Seluler dan Kendaraan Perusahaan


KEP-316/PJ./2002 17/06/2002 Perlakuan Pajak Penghasilan atas Pengeluaran/Biaya Perolehan Perangkat Lunak (Software) Komputer

37. Surat Edaran Dirjen Pajak

SE-04/PJ.42/2002 02/04/2002 Perlakuan Pajak Penghasilan Atas Pemberian Imbalan Bunga Kepada Wajib Pajak


SE-07/PJ.42/2002 08/05/2002 Penghitungan Penyusutan Atas Komputer, Printer, Scanner dan Sejenisnya


SE-08/PJ.42/2002 17/05/2002 Pengakuan Penghasilan Atas Penghasilan Bank Berupa Bunga Kredit Non-Performing


SE-09/PJ.42/2002 17/05/2002 Perlakuan Pajak Penghasilan atas Biaya Pemakaian Telepon Seluler dan Kendaraan Perusahaan


SE-02/PJ.42/2003 04/02/2003 kewajiban Mencantumkan Nomor Pokok Wajib Pajak dalam SPT Tahunan Pajak Penghasilan Wajib Pajak Badan Bagi Pemegang Saham/Pemilik Modal, Pengurus dan Komisaris


SE-03/PJ.31/2004 03/03/2004 Kompensasi Kerugian Fiskal dalam Penghitungan Pajak Penghasilan


SE-01/PJ.33/2005 19/01/2005 Pemberian Imbalan Bunga Kepada Wajib Pajak

` Notes: All the Taxation Regulation above can be found at website http://www.pajak.go.id

PDF FORM 1771

a. Folio/Government Legal (8,5 X 13 inch); b. Minimum weight of 70 gr

others are available in this form, so that taxpayers do not need to do a recount;

5. <AUTO> sign shows the calculation results automatically. There are times when automatic

re-checking of results of calculations on this tax return, especially in the field <AUTO> ;

7. SHOW button is used to display calculation formulas in filling this form;

8. RESET button is used to clean up this form from the information that has been loaded previously. After completing the income tax annual return and print it, do not forget to save to another file (Save-as and give it a name that is different from the original file), then use the RESET button to clear the file;

you want to do it manually filling;

1. This form is in compliance with the Director General of Taxes Decree No. Per-

be used for completion of income tax annual return form tax year 2010 and onwards.

2. The Tax Return shall be signed by the Taxpayer or his/her authorized proxy/representative and paper should not be folded or rumpled. For printing use the HVS paper size :

3. To be able to use this form optimally, please use Adobe Reader version 8 or newer and recharge by clicking on the field to be filled. To know which field that can be filled in, please click on

has been included in the CD or can be downloaded by the Taxpayer for free on the Internet; the menu HIGHLIGHTS FIELDS located on the upper right. The Adobe Reader application itself

4. Fill the first annexes. Summation and reduction formulas, due to certain sections and

then press DELETE key followed by ENTER. However, Taxpayer is expected to keep doing

9. HIDE button is used to hide the calculation formulas so that it can be printed blank form if

calculation is too late to execute, to make sure it runs well, point the cursor pointer tothe field where the calculation formula should be run, block the numbers there,

6. If additional form of 1771-III, 1771-IV, 1771-V and 1771-VI are needed more because the information to be loaded is more than one page, that forms are now available in the directory (folder) . These files can be reproduced to adjust the needs in a way to copy and replace filename (rename), for example: 1770-III-1, 1771-III-2 etc;

GENERAL INSTRUCTIONS FOR THE COMPLETION

34/PJ/2010 about Income Tax Annual Return Form and General Instructions and can only

10. More complete explanations about annual income tax return completion are available in softcopy version of the Income Tax Annual Guidebook included in this digital form;

ATTENTION: • FOLLOW INSTRUCTIONS

• PRINT OR TYPE WITH CAPITAL LETTER OR BLACK INK

• MARK "X" IN THE APPROPRIATE BOX

T I N :

TAXPAYER'S NAME :

BUSINESS CLASIFICATION : KLU :

TELEPHONE NUMBER : ‐ ‐

ACCOUNTING PERIOD : to

FINANCIAL STATEMENT : AUDITED AUDIT OPINION UNAUDITED

NAME OF PUBLIC ACCOUNTANT FIRM :

T I N OF PUBLIC ACCOUNTANT FIRM :

NAME OF CPA :

T I N OF CPA :

NAME OF TAX CONSULTANT FIRM :

T I N OF TAX CONSULTANT FIRM :

NAME OF TAX CONSULTANT :

T I N OF TAX CONSULTANT :

*) The filling of coloumns of Rupiahs must be without decimal value (see example in Intructions page. 3)

1. FISCAL NET INCOME

(Copy from Form 1771-I line 8 column 3) ………………………………………

2. FISCAL LOSS CARRY FORWARD (Copy from Special Attachment 2A Total of column 8) ………………………

3. TAXABLE INCOME (1-2) ……...…..…………………………….

4. INCOME TAX DUE (Choose one of these Rates according to Taxpayer criteria. See Instructions)

a. Tax Rate Article 17 paragraph (1) letter b X line 3 …….

b. Tax Rate Article 17 paragraph (2b) X line 3 ……..…………………

c. Tax Rate Article 31E paragraph (1)(See Instructions)

5.

6. TOTAL TAX DUE (4 + 5) …..…………………………………….

7. INCOME TAX BORNED BY THE GOVERNMENT (Foreign Aid Project) …

8. a. DOMESTIC TAX CREDIT (Copy from Form 1771-III Total of column 6) ……….……………..…...

b. FOREIGN TAX CREDIT (Copy from Special Attachment 7A Total of column 8) ……….…………

9. a. TAX DO AFTER CREDIT

b. TAX OVERLY WITHHELD

10. PREPAID TAX: a. MONTHLY INSTALLMENT TAX ARTICLE 25….……..………………..

b. NOTICE OF TAX COLLECTION (Principal only) …….….…..……….…

c. TOTAL (10a + 10b) …….……………………...………………

11. a. UNDERPAID TAX (INCOME TAX ARTICLE 29)

b. OVERPAID TAX (INCOME TAX ARTICLE 28A)

12. UNDERPAID TAX ON NUMBER 11.a SETTLED ON …………..

13. OVERPAID AMOUNT STATED IN 11.b WOULD BE:

a. REFUNDED b. COMPENSATED WITH OUTSTANDING TAX PAYABLE

Refund for a Taxpayer with Certain Criteria only: Preliminary Refund (Tax Law on Article 17C or 17D )

F.1.1.32.14

ANNUAL INCOME TAX RETURNFOR CORPORATE

DATE

10b

c. TOTAL ( 8a + 8b ) ……...……………..….…………………………….

10a

8b

3

5

(6 – 7 – 8c) …

8c

ADJUSTMENT FOR FOREIGN TAX CREDIT REFUNDED THAT HAD BEEN CREDITED IN THE PREVIOUS YEAR'S RETURN (Income Tax Art. 24)

1

DIRECTORATE GENERAL OF TAXES

B.

INC

OM

E T

AX

DU

EF

OR

M 1771MINISTRY OF FINANCE OF THE

REPUBLIC OF INDONESIA

(3)

2

6

IDR*)

IDE

NT

ITY

(1) (2)

C. T

AX

CR

ED

ITS

8a

MONTH

FACSIMILE NO:

FOREIGN DOMICILE OF HEAD OFFICE (Permanent Establisment only)

A. T

AX

AB

LE

INC

OM

E

10c

(9 – 10c) …

7

YEAR

9

11

D. I

NC

OM

E T

AX

UN

DE

R/O

VE

R

PA

ID

4

……...AMENDED RETURN

TAXABLE YEAR

2 0

Form 1771 Page 2

14. a.

b. FISCAL LOSS CARRY FORWARD: (From Special Attachment 2A Total of Column 9) .………... Ø

c. TAXABLE INCOME (14a – 14b) …..…………………………… Ø

d. TAX DUE……………………………………………….. ( Tax Rate from Part B line 4 X 14c) Ø

Ø

f. INCOME TAX MUST BE PAID (14d – 14e) …………………… Ø

g. INCOME TAX ARTICLE 25 : (1/12 X 14f) ………..…….………Ø

15 a. FINAL TAX : (From Form 1771-IV Total Part A Column 5) …..……..………Ø

b. NON-TAXABLE INCOME: GROSS INCOME (From Form 1771-IV Total Part B of Column 3) …..……..……Ø

16 a.

b.

17 OTHER THAN FORM OF 1771-I, 1771-II, 1771-III, 1771-IV, 1771-V, AND 1771-VIWITH THIS ALSO ATTACHED:

a. THIRD COPY OF TAX PAYMENT RECEIPT OF INCOME TAX ARTICLE 29

b. FINANCIAL STATEMENTS

c. TRANCRIPT OF CITATION OF ELEMENTS FROM FINANCIAL STATEMENT (Special Attachment 8A-1 / 8A-2 / 8A-3 / 8A-4 / 8A-5 / 8A-6 / 8A-7 / 8A-8)*

d. DEPRECIATION AND AMORTIZATION TABLES (Special Attachment 1A of Annual Income Tax Return Manual)*

e. CALCULATION OF FISCAL LOSS CARRY FORWARD (Special Attachment 2A of Income Tax Return Manual)*

f. INVESTMENT FACILITIES PROVIDED (Special Attachment 4A of the Income Tax Return Manual)

g. LIST OF MAJOR BRANCHES (Special Attachment 5A of the Income Tax Return Manual)

h. THIRD COPY OF PAYMENT RECEIPT OF INCOME TAX ARTICLE 26 PARAGRAPH (4) (For Permanent Establishment only)

i. CALCULATION OF INCOME TAX ART. 26 PARAGRAPH (4) (Permanent Establishment only) (Special Attachment 6A of Income Tax Return Manual)*

j. FOREIGN TAX CREDITS (Special Attachment 7A Income Tax Return Manual)*

k. POWER OF ATTORNEY (If needed)

l.

m.

n.

*

Understanding All The Sanctions Provided by The Law and Regulations, I Hereby Declare that The Information Stated in this Return, IncludingAll Attachments Provided, are True, Complete, Clear, and Under No Circumstances Whatsoever.

a. TAXPAYER b. c. …………………………………, d.

(Place)

SIGNATURE AND COMPANY SEAL:

FULL NAME

: e.

T I N : f.

F.1.1.32.14

MANAGEMENT / REPRESENTATIVE

INCOME BASE FOR CALCULATION OF MONTHLY TAX INSTALLMENT…………………………………………..

All Attachment above can be downloaded on website http://www.pajak.go.id. or take it at the nearest Tax Office.

month

DECLARATION

15b

(1) (2)

(Compulsory to submit Special Attachment 3A, 3A-1, and 3A-2 Manual Book of Annual Return)*

There is not a Transaction in Related Parties and/or with Tax Heaven Country Resident.

AUTHORIZED REPRESENTATIVE

14c

E.

MO

NT

HL

Y I

NS

TA

LL

ME

NT

OF

AR

T.

25

FO

R C

UR

RE

NT

YE

AR

G. S

TA

TE

ME

NT

OF

T

RA

NS

AC

TIO

N IN

R

EL

AT

ED

PA

RT

IES

14g

15a

14d

14b

14e

14f

There is a Transaction in Related Parties and/or with Tax Haven Country Resident

e.

(3)

IDR

14a

yeardate

H.A

TT

AC

HM

EN

TS

F. F

INA

L T

AX

AN

D N

ON

-T

AX

AB

LE

INC

OM

E

WITHHOLDING TAX PAID BASED ON NUMBER 14a

T I N :

TAXPAYER'S NAME :

ACCOUNTING PERIOD :

DOMESTIC COMMERCIAL NET INCOME:

a. GROSS INCOME Ø

b. COST OF GOOD SOLD …………...…………...…………...…………...…………...… Ø

c. OTHER EXPENSES .…………...…………....…………...…………....…………...…… Ø

d. NET INCOME FROM BUSINESS ( 1a - 1b - 1c ) ..…………...………….....………… Ø

e. INCOME FROM NON BUSINESS ACTIVITIES .…………...…………....………….. Ø

f. EXPENSE FROM NON BUSINESS ACTIVITIES.…………...…………....………… Ø

g. NET INCOME FROM NON BUSINESS ACTIVITIES ( 1e - 1f )..…….…………..... Ø

h. TOTAL ( 1d + 1g ) : .…………...…………....…………...…………....………… Ø

FOREIGN COMMERCIAL NET INCOME

(From Special Attachment 7A Column 5) .…………...…………....…………...………….. Ø

TOTAL OF COMMERCIAL NET INCOME (1h + 2) …………………...………………… Ø

INCOME SUBJECT TO FINAL TAX

AND NON-TAXABLE INCOME ..…………...………….....…………...………….....……… Ø

POSITIVE ADJUSTMENT:

a. EXPENSES CHARGED OR INCURRED FOR THE PERSONAL BENEFIT OF

SHAREHOLDERS, PARTNERSHIP OR MEMBERS. ..…………...………….....…… Ø

b. FORMATION OR ACCUMULATION OF ALLOWANCES..…………...…………..... Ø

c. CONSIDERATION OR REMUNERATION RELATED TO EMPLOYMENT OR

SERVICES GIVEN IN THE FORM OF A BENEFIT IN KIND..…………...………… Ø

d. EXCESSIVE COMPENSATION PAID TO SHAREHOLDERS OR OTHER

ASSOCIATED PARTIES AS A CONSIDERATION OF WORK PERFORMED

………………………………………………………………………………………… Ø

e. GIFTS, AIDS OR DONATION ..…………...………….....…………...………….....… Ø

f. INCOME TAX.…………...………….....…………...………….....…………...………… Ø

g. SALARIES PAID TO A MEMBER OF ASSOCIATION, FIRMA, OR LIMITED

PARTNERSHIP WHICH CAPITAL DOES NOT CONSIST OF STOCKS..………… Ø

h. ADMINISTRATION PENALTIES ..…………...………….....…………...…………..... Ø

i. LESS COMMERCIAL DEPRECIATION OVER FISCAL DEPRECIATION ..……… Ø

j. LESS COMMERCIAL AMORTIZATION OVER FISCAL AMORTIZATION ..……… Ø

k. DEFERRED EXPENSES Ø

l. OTHER POSITIVE FISCAL ADJUSTMENTS ..…………...………….....…………... Ø

m. TOTAL 5a to 5l : ..…………...………….....…………...………….....………… Ø

NEGATIVE FISCAL ADJUSTMENT:

a. LESS COMMERCIAL DEPRECIATION UNDER FISCAL DEPRECIATION..……… Ø

b. LESS COMMERCIAL AMORTIZATION UNDER FISCAL AMORTIZATION..……… Ø

c. DEFERRED INCOME Ø

d. OTHER NEGATIVE FISCAL ADJUSTMENTS..…………...………….....………….. Ø

e. TOTAL 6a to 6d ..…………...………….....…………...………….....…………...… Ø

FACILITIES OF INVESTMENT ALLOWANCES

………YEAR 7a (From Special Attachment 4A Line 5b) ..…………...…… Ø

NOTES : Copy Total of Line 8 to Form 1771 Letter A Line 1.

D.1.1.32.31

MINISTRY OF FINANCE OF THE REPUBLIC OF INDONESIA

1771 - IFO

RM

5h

6e

6b

5j

5k

5a

6c

7b

5l

5e

5g

5m

5c

5b

8.

5f

7.

6.6a

6d

FISCAL NET INCOME (3 - 4 + 5m - 6e - 7b) ..…………...………….....…………..

5i

8

TA

XA

BL

E Y

EA

R


(2)


NO IDR(3)

DESCRIPTIONS

to

(1)

IDE

NT

ITY

1a

1.

5.

2.

3.

4.4

3

2

1h

1b

1c

1d

1e

5d

1f

1g

ATTACHMENT - I

CALCULATION OF FISCAL NET INCOME

2 0 A A


ACCOUNTING PERIOD :

(1)

1. PURCHASE OF MATERIAL/MERCHANDISE

2.

3. TRANSPORTATION EXPENSE

4.

5. RENTAL EXPENSES

6. INTEREST EXPENSE

7. EXPENSE RELATED TO SERVICE

8. BAD DEBT EXPENSE

9. ROYALTIES EXPENSE

10. MARKETING AND PROMOTION EXPENSE

11. OTHER EXPENSES

12. BEGINNING INVENTORY

13. ENDING INVENTORY (-/-)

Note:• Number 1 for Trading Company fill with inventory, for industry fill with purchase of material, indirect material and finished good.• Number 7 includes management fee, technical assistance fee, and other services • Line 11 includes total expenses not covered in Line 1 to 10•

D.1.1.32.54


SALARIES, WAGES, BONUSES, GRATIFICATIONS

DETAILS OF COST OF GOOD SOLD, OTHER OPERATING EXPENSE AND COMMERCIAL NON-OPERATING EXPENSE

Line 12 and 13 for trading companies, filled with beginning/ending balances of merchandise inventory, for industrial companies, filled with beginning/ending balances of raw materials, indirect materials, work in process, and finished goods inventory

DEPRECIATION AND AMORTIZATION EXPENSE

(6) = (3) + (4) + (5)(5)

IDE

NT

ITY

(IDR)(4)

NO.

(2)

to

(IDR)

TOTAL OF LINE 1 TO 12 MINUS LINE 1314

OTHER OPERATING EXPENSECOST OF GOOD SOLD

(3)

DETAILS(IDR)(IDR)


ATTACHMENT- II ANNUAL INCOME TAX RETURN FOR CORPORATE

TA

XA

BL

E Y

EA

R

TOTALNON-OPERATING EXPENSE

FO

RM 1771 - II

2 0 A A

T I N : TAXPAYER'S NAME:

BOOKS OF ACCOUNT PERIOD :

NO.

(1)

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

etc

TOTAL

Notes:• Filled with calculation of each Withholding Tax Receipt.• Copy of Total Income Tax Article 22, Income Tax Article 23 and Income Tax Article 26 column (6) to Form 1771 Letter C Line 8.a.

Page- from page Attachment-III

D.1.1.32.32

WITHHOLDING AGENT

NAME

(2) (3)

TIN

(5)

(IDR)

(4)

WITHHOLDING OBJECTTYPES OF INCOME/

TRANSACTION

1771 - III


IF NEEDED. ADDITIONAL PAGES MAY BE ADDEED

TTL

(7)(6) (8)


DATE

TA

XA

BL

E Y

EA

R

WITHHOLDING RECEIPT/TAX PAYMENT SLIP (SSP)/SSPCP


(IDR)

INCOME TAX WITHHELD

FO

RM

FOREIGN TAX CREDIT

to

IDE

NT

ITY

ATTACHMENT - III

NUMBER

2 0A A

T I N :

TAXPAYER'S NAME :


PART A: FINAL INCOME TAX

INCOME FROM SALES VALUES OF SHARE

TRADED IN STOCK EXCHANGE

INCOME FROM DISTRIBUTOR / DEALER /

AGENT OF OIL PRODUCTS

CONSTRUCTION RELATED FEE:

a. CONTRUCTOR

b. DESIGNER

c. CONSTRUCTION SUPERVISOR

GROSS SALES OF REPRESENTATIVE OFFICE

REVALUATION OF FIXED ASSET

PART B : NON-TAXABLE INCOME

AID/DONATION

GRANT

CONTRIBUTION AND SPECIFIC INCOME RECEIVED BY A PENSION FUND

…………………………………………………….…………

page- page Attachment-IV

D.1.1.32.34


(2)

TYPES OF INCOME

4.

5.

etc.

2.

1771 - IVMINISTRY OF FINANCE OF THE



1.

(3) (4)

RATE(%)

3.

(1)

TYPES OF INCOME

(2)

FO

RM

IDE

NT

ITY

NO.INCOME TAX PAYABLE

(IDR)

(5)

TA

XA

BL

E Y

EA

R


FINAL INCOME TAX AND NON-TAXABLE INCOME

to

ATTACHMENT - IV

TAX BASE(IDR)

9.

10.

6.

7.

3.

7.

(1)

2.

1.

6.

4.

NO

Copy to Form 1771 letter F line 15 point b

GROSS INCOME

(IDR)

(3)

TOTAL PART B TPB

5.

14.

12.

8.

13.

GROSS INCOME OF DOMESTIC SHIPPING COMPANY

GROSS INCOME OF FOREIGN SHIPPING / AIRLINES COMPANY

11.

Copy of Form 1771 letter F line 15 point a

TOTAL PART A

SHARES OF PROFIT RECEIVED BY VENTURE CAPITAL COMPANIES FROM ITS PARTNERS

TPA

……………………………………………………………

DIVIDEND FROM INVESTMENT/OWNERSHIP OF SHARES OF THE INDONESIAN BUSINESS ENTITIES (Article 4 Paragraph (3) Item f of Income Tax Law)

from

EXCESS INCOME RECEIVED BY NONPROFIT AND REGISTERED EDUCATION INSTITUTION OR RESEARCH AND DEVELOPMENT ESTABLISHMENT WHICH ARE REINVESTED IN THE FORM OF FACILITIES AND IN INFRASTRUCTURE FOR EDUCATIONAL AND/OR R&D ACTIVITIES.

INTEREST INCOME ON TIME DEPOSITS/OTHER SAVINGS AND DISCOUNT OF CENTRAL BANK'S SERTIFICATE/SECURITIES STATE

INTEREST/DISCOUNT OF BOND

INCOME FROM TRANSFER VALUE OF RIGHT ON LAND/BUILDING

INCOME FROM LEASE/RENT VALUE OF LAND/BUILDING

DERIVATIVE TRANSACTION TRADE IN CAPITAL MARKET

INCOME FROM SALES VALUE OF VENTURE CAPITAL SHARE

2 0 A A

• LIST OF SHAREHOLDERS/CAPITAL OWNERS AND TOTAL DIVIDENDS DISTRIBUTED

• LIST OF DIRECTORS AND COMMISSIONERS

T I N :

TAXPAYER'S NAME :


PART A: LIST OF SHAREHOLDERS/CAPITAL OWNERS AND TOTAL DIVIDENDS DISTRIBUTED

PART B: LIST OF DIRECTORS AND COMMISSIONERS

Page page Attachment-V

D.1.1.32.35


T I NNAME ADDRESS

(2) (3) (4)


TA

XA

BL

E Y

EA

R

(1)

FO

RM 1771 - V

ATTACHMENT - V ANNUAL INCOME TAX RETURN FOR CORPORATE

to

IDE

NT

ITY

NO%

(2)

NAME ADDRESS T I N

(3) (4)

1.

NO

(1)

2.

3.

7.

10.

etc

DIVIDENDTOTAL PAID IN SHARES

(5)(IDR)

(7)(IDR)

(6)

10.

(5)

POSITION

4.

5.

6.

5.

8.

8.

TPA

etc

3.

6.

7.

1.

2.

4.

9.

9.

from


100%TOTAL PART A

2 0 A A

• LIST OF CAPITAL CONTRIBUTION IN AFFILIATION COMPANIES

• LIST OF ACCOUNT PAYABLE FROM SHARESHOLDERS AND/OR AFFILIATION COMPANIES

• LIST OF ACCOUNT RECEIVABLE TO SHARESHOLDERS AND/OR AFFILIATION COMPANIES

T I N :

TAXPAYER'S NAME :


PART A : LIST OF CAPITAL CONTRIBUTION IN AFFILIATION COMPANIES

(1)

5.

etc.

PART B : LIST OF ACCOUNT PAYABLE FROM SHARESHOLDER AND/OR AFFILIATION COMPANIES

(1)

1.

2.

3.

4.

5.

6.

7.

8.

9

10.

11.

12.

etc.

PART C : LIST OF ACCOUNT RECEIVABLE TO SHARESHOLDER AND/OR AFFILIATION COMPANIES

(1)

1.

2.

3.

4.

5.

6.

7.

8.

9

10.

11.

12.

etc.

Page- page Attachment-VI

D.1.1.32.36

TA

XA

BL

E Y

EA

R

FO

RM 1771 - VI

IDE

NT

ITY

to


ATTACHMENT - VI



NO%

ADDRESS T I NAMOUNT OF CAPITAL CONTRIBUTION

(IDR)NAME

(6)

1.

(2) (3) (4) (5)

2.

3.

TOTAL

NO NAME T I NTOTAL LOAN

4.

INTEREST/YR

(IDR) %

TTL

YEAR

(2) (3) (4) (5) (6)

(6)

INTEREST/YR

%

(4) (5)



YEAR(IDR)

from

(2) (3)

2 0 A A

PETUNJUK UMUM PENGISIAN FORMULIR DIGITAL SPT 1771

1. Format SPT ini telah sesuai dengan Peraturan Direktur Jenderal Pajak Nomor Per-

34/PJ/2010 Tentang Bentuk Formulir Surat Pemberitahuan Tahunan Pajak Penghasilan Wajib Pajak Orang Pribadi Dan Wajib Pajak Badan Beserta Petunjuk Pengisiannya dan hanya dapat digunakan untuk pengisian SPT Tahun Pajak 2010 dan seterusnya.

2. SPT hasil pencetakan ini wajib ditanda tangani dan tidak boleh dilipat atau kusut. Untuk pencetakan gunakan hanya kertas HVS berukuran:

Folio/Government Legal (8,5 x 13 inch)

Berat minimal 70 gr

3. SPT Digital ini dapat dibuka dan diisi dengan aplikasi Adobe Reader versi 8 ke atas atau aplikasi pdf reader sejenis dan lakukan pengisian dengan mengklik Field yang akan diisi. Untuk mengetahui Field yang dapat diisi silahkan klik pada menu HIGHLIGHT FIELDS yang terletak pada bagian kanan atas. Sementara untuk aplikasi Adobe Reader telah disertakan dalam CD atau dapat di unduh sendiri oleh Wajib Pajak secara gratis di internet;

4. Isilah dari lampiran-lampirannya terlebih dahulu. Rumus-rumus penjumlahan, pengurangan, kaitan dengan bagian tertentu dan lainnya telah tersedia pada form ini, sehingga WP tidak perlu melakukan penghitungan kembali;

5. Tanda <AUTO> menunjukan hasil perhitungan otomatis. Ada kalanya perhitungan otomatis ini terlambat melakukan eksekusi, untuk memastikan telah berjalan dengan baik, arahkan kursor penunjuk ke sel di mana rumus perhitungan seharusnya berjalan, blok angka yang ada, selanjutnya tekan tombol DELETE dilanjutkan dengan ENTER. Namun demikian Wajib Pajak diharapkan tetap melakukan pengecekan ulang atas hasil perhitungan pada SPT ini terutama pada field <AUTO>;

6. Jika formulir Lampiran 1771-III, 1771-IV, 1771-V dan 1771-VI diperlukan lebih banyak lagi karena data yang akan diisikan lebih dari 1 (satu) halaman, didalam direktori (folder ) SPT ini telah tersedia file dimaksud. File-file tersebut dapat diperbanyak dengan cara di-copy dan diganti nama filenya (rename), (mis. 1771-III-1, 1771-III-2 dst) sesuaikan dengan kebutuhan;

7. Tombol SHOW digunakan untuk menampilkan rumus-rumus perhitungan dalam pengisian SPT secara digital;

8. Tombol RESET digunakan untuk membersihkan file pdf ini dari data yang telah diisikan sebelumnya. Setelah selesai mengisi SPT dan mencetaknya, jangan lupa simpan ke file lain (Save-as dan beri nama yang berbeda dengan file semula), kemudian gunakan tombol RESET untuk membersihkan file;

9. Tombol HIDE digunakan untuk menyembunyikan rumus-rumus perhitungan sehingga Formulir ini dapat dicetak kosong apabila ingin dilakukan pengisian secara manual;

10. Penjelasan lebih lengkap mengenai pengisian SPT Tahunan silahkan baca Buku Petunjuk Pengisian SPT Tahunan yang bentuk softcopy-nya disertakan dalam SPT digital ini;

PERHATIAN: • SEBELUM MENGISI, BACA DAHULU BUKU PETUNJUK PENGISIAN

• ISI DENGAN HURUF CETAK/DIKETIK DENGAN TINTA HITAM

• BERI TANDA "X" PADA (KOTAK PILIHAN) YANG SESUAI

N P W P :

NAMA WAJIB PAJAK :

JENIS USAHA : KLU :

NO. TELEPON : - NO. FAKS : -

PERIODE PEMBUKUAN : s.d.

NEGARA DOMISILI KANTOR PUSAT (khusus BUT) :

PEMBUKUAN / LAPORAN KEUANGAN : DIAUDIT OPINI AKUNTAN TIDAK DIAUDIT

NAMA KANTOR AKUNTAN PUBLIK :

NPWP KANTOR AKUNTAN PUBLIK :

NAMA AKUNTAN PUBLIK :

N P W P AKUNTAN PUBLIK :

NAMA KANTOR KONSULTAN PAJAK :

N P W P KANTOR KONSULTAN PAJAK :

NAMA KONSULTAN PAJAK :

NPWP KONSULTAN PAJAK :

*) Pengisian kolom-kolom yang berisi nilai rupiah harus tanpa nilai desimal (contoh penulisan lihat buku petunjuk hal. 3)

1. PENGHASILAN NETO FISKAL (Diisi dari Formulir 1771-I Nomor 8 Kolom 3) ………………………………………………………………….

2. KOMPENSASI KERUGIAN FISKAL (Diisi dari Lampiran Khusus 2A Jumlah Kolom 8) …………………………

3. PENGHASILAN KENA PAJAK (1-2) ……...…..…………………………….

4. PPh TERUTANG (Pilih salah satu sesuai dengan kriteria Wajib Pajak. Untuk lebih jelasnya, lihat Buku Petunjuk Pengisian SPT)

a. Tarif PPh Ps. 17 Ayat (1) Huruf b X Angka 3 …….

b. Tarif PPh Ps. 17 ayat (2b) X Angka 3 ……..…………………..

c. Tarif PPh Ps. 31E ayat (1) (Lihat Buku Petunjuk)

5. PENGEMBALIAN / PENGURANGAN KREDIT PAJAK LUAR NEGERI (PPh Ps. 24) YANG TELAH DIPERHITUNGKAN TAHUN LALU …………

6. JUMLAH PPh TERUTANG (4 + 5) …..…………………………………….

7. PPh DITANGGUNG PEMERINTAH (Proyek Bantuan Luar Negeri) ……..………………..………………..………

8. a. KREDIT PAJAK DALAM NEGERI (Diisi dari Formulir 1771-III Jumlah Kolom 6) ……….……………..…....………………..………………..………………..……

b. KREDIT PAJAK LUAR NEGERI (Diisi dari Lampiran Khusus 7A Jumlah Kolom 8) ……….………………..………………..………………..………………..…

c. JUMLAH ( 8a + 8b ) ……...……………..….…………………………………………………………………………..………

9. a. PPh YANG HARUS DIBAYAR SENDIRI b. PPh YANG LEBIH DIPOTONG / DIPUNGUT

10. PPh YANG DIBAYAR SENDIRI a. PPh Ps. 25 BULANAN ….……..………………..…………………………………..…………………..…………

b. STP PPh Ps. 25 (Hanya Pokok Pajak) …….….…..……….…………………………………………………

c. JUMLAH (10a + 10b ) …….……………………...………………

11. a. PPh YANG KURANG DIBAYAR (PPh Ps. 29) b. PPh YANG LEBIH DIBAYAR (PPh Ps. 28A)

12. PPh YANG KURANG DIBAYAR PADA ANGKA 11.a DISETOR TANGGAL …………..

13. PPh YANG LEBIH DIBAYAR PADA ANGKA 11.b MOHON :

a. DIRESTITUSIKAN b. DIPERHITUNGKAN DENGAN UTANG PAJAK

Khusus Restitusi untuk Wajib Pajak dengan Kriteria Tertentu : Pengembalian Pendahuluan (Pasal 17C atau Pasal 17D UU KUP)

F.1.1.32.14

TAHUN PAJAK

SPT PEMBETULAN

1771SPT TAHUNAN

PAJAK PENGHASILAN WAJIB PAJAK BADAN 2 0

KE- …

11

D. P

Ph K

UR

AN

G/ L

EBIH

BA

YAR

4

THNBLN

10c

FOR

MU

LIR

KEMENTERIAN KEUANGAN RI

DIREKTORAT JENDERAL PAJAK

IDEN

TITA

S

(1) (2)

2

6

1

8b

3

5

7

RUPIAH *)

(6 – 7 – 8c) …

10a

A. P

ENG

HA

SILA

N

KEN

A P

AJA

KB

. PP

h TE

RU

TAN

G

(3)

C.

KR

EDIT

PA

JAK

8a

TGL

(9 – 10c) ……

10b

9

8c

Formulir 1771 Halaman 2

14. a. PENGHASILAN YANG MENJADI DASAR PENGHITUNGAN ANGSURAN ………..……………………………………………………………………

b. KOMPENSASI KERUGIAN FISKAL: (Diisi dari Lampiran Khusus 2A Jumlah Kolom 9) .………………

c. PENGHASILAN KENA PAJAK (14a – 14b) …..…………………………………….…………………..………..

d. PPh YANG TERUTANG (Tarif PPh dari Bagian B Nomor 4 X 14c) ………………………….

e. KREDIT PAJAK TAHUN PAJAK YANG LALU ATAS PENGHASILAN YANG TERMASUK DALAM ANGKA 14a YANG DIPOTONG / DIPUNGUT OLEH PIHAK LAIN …..……..………...…..……..………………..

f. PPh YANG HARUS DIBAYAR SENDIRI (14d – 14e) ………………………………………………..………..

g. PPh PASAL 25 : (1/12 X 14f) ………..…….…………………………………………………..………….

15 a. PPh FINAL : (Diisi dari Formulir 1771-IV Jumlah Bagian A Kolom 5) …..……..………...…..……..………………..

b. PENGHASILAN YANG TIDAK TERMASUK OBJEK PAJAK : PENGHASILAN BRUTO (Diisi dari Formulir 1771-IV Jumlah Bagian B Kolom 3) …..……..………...…..……..………………..

16 a.

b.

17 SELAIN LAMPIRAN-LAMPIRAN 1771-I, 1771-II, 1771-III, 1771-IV, 1771-V, DAN 1771-VIBERSAMA INI DILAMPIRKAN PULA :

a. SURAT SETORAN PAJAK LEMBAR KE-3 PPh PASAL 29

b. LAPORAN KEUANGAN

c. TRANSKRIP KUTIPAN ELEMEN-ELEMEN DARI LAPORAN KEUANGAN (Lampiran Khusus 8A-1 / 8A-2 / 8A-3 / 8A-4 / 8A-5 / 8A-6 / 8A-7 / 8A-8)*

d. DAFTAR PENYUSUTAN DAN AMORTISASI FISKAL (Lampiran Khusus 1A Buku Petunjuk Pengisian SPT)*

e. PERHITUNGAN KOMPENSASI KERUGIAN FISKAL (Lampiran Khusus 2A Buku Petunjuk Pengisian SPT)*

f. DAFTAR FASILITAS PENANAMAN MODAL (Lampiran Khusus 4A Buku Petunjuk Pengisian SPT)*

g. DAFTAR CABANG UTAMA PERUSAHAAN (Lampiran Khusus 5A Buku Petunjuk Pengisian SPT)*

h. SURAT SETORAN PAJAK LEMBAR KE-3 PPh PASAL 26 AYAT (4) (Khusus bagi BUT)

i. PERHITUNGAN PPh PASAL 26 AYAT (4) (Khusus BUT) (Lampiran Khusus 6A Buku Petunjuk Pengisian SPT)*

j. KREDIT PAJAK LUAR NEGERI (Lampiran Khusus 7A Buku Petunjuk Pengisian SPT)*

k. SURAT KUASA KHUSUS (Bila dikuasakan)

l.

m.

n.

*

Dengan menyadari sepenuhnya akan segala akibatnya termasuk sanksi-sanksi sesuai dengan ketentuan perundang-undangan yang berlaku,saya menyatakan bahwa apa yang telah saya beritahukan di atas beserta lampiran-lampirannya adalah benar, lengkap dan jelas.

a. WAJIB PAJAK b. KUASA c. …………………………………, d.(Tempat)

TANDA TANGAN DAN CAP PERUSAHAAN :

NAMA LENGKAP

PENGURUS / KUASA : e.

N P W P : f.

F.1.1.32.14

H. L

AM

PIR

AN

F. P

Ph F

INA

L D

AN

PE

NG

HA

SILA

N B

UK

AN

O

BJE

K P

AJA

KE.

AN

GSU

RA

N P

Ph P

ASA

L 25

TA

HU

N B

ERJA

LAN

14f

G. P

ERN

YATA

AN

TR

AN

SAK

SI D

ALA

M

HU

BU

NG

AN

ISTI

MEW

A

14g

15a

14d

14b

14a

Tidak Ada Transaksi Dalam Hubungan Istimewa dan/atau Transaksi dengan Pihak yang Merupakan Penduduk Negara Tax Haven

Country .

thntgl

(3)RUPIAH

bln

(Wajib melampirkan Lampiran Khusus 3A, 3A-1, dan 3A-2 Buku Petunjuk Pengisian SPT)*

14c

PERNYATAAN

15b

Wajib Pajak dapat langsung mengunduh dari situs Direktorat Jenderal Pajak dengan alamat http://www.pajak.go.id. atau mengambil di KPP/KP2KP terdekat.

(1) (2)

Ada Transaksi Dalam Hubungan Istimewa dan/atau Transaksi dengan Pihak yang Merupakan Penduduk Negara Tax Haven Country.

14e

N P W P :

NAMA WAJIB PAJAK :

PERIODE PEMBUKUAN :

PENGHASILAN NETO KOMERSIAL DALAM NEGERI :

a. PEREDARAN USAHA …………..……………………………...…………...…………...…………...……………...…...………………………….Ø

b. HARGA POKOK PENJUALAN …………...…………...…………...…………...…………...…………...…………...…………...…………...…….Ø

c. BIAYA USAHA LAINNYA .…………...…………....…………...…………....…………...…………....…………...…………....…………...……Ø

d. PENGHASILAN NETO DARI USAHA ( 1a - 1b - 1c ) ..…………...………….....…………...………….....…………...………….....…………...….Ø

e. PENGHASILAN DARI LUAR USAHA .…………...…………....…………...…………....…………...…………....…………...………………….Ø

f. BIAYA DARI LUAR USAHA .…………...…………....…………...…………....…………...…………....…………...…………....…………...……Ø

g. PENGHASILAN NETO DARI LUAR USAHA ( 1e - 1f )..…….………….....…………...…...………..…….....…....…………...……….Ø

h. JUMLAH ( 1d + 1g ) : .…………...…………....…………...…………....…………...…………....…………...…………....…………...……………….Ø PENGHASILAN NETO KOMERSIAL LUAR NEGERI (Diisi dari Lampiran Khusus 7A Kolom 5) .…………...…………....…………...…………....…………...…………....…………...………………….Ø

JUMLAH PENGHASILAN NETO KOMERSIAL (1h + 2) …………………...…………………...…………………...………………….…………...………Ø

PENGHASILAN YANG DIKENAKAN PPh FINAL DAN YANG TIDAK TERMASUK OBJEK PAJAK ..…………...………….....…………...………….....…………...………….....…………...…….Ø

PENYESUAIAN FISKAL POSITIF : a. BIAYA YANG DIBEBANKAN / DIKELUARKAN UNTUK KEPENTINGAN

PEMEGANG SAHAM, SEKUTU, ATAU ANGGOTA. ..…………...………….....…………...………….....…………...……………………………Ø

b. PEMBENTUKAN ATAU PEMUPUKAN DANA CADANGAN ..…………...………….....…………...………….....…………...……………..Ø c. PENGGANTIAN ATAU IMBALAN PEKERJAAN ATAU

JASA DALAM BENTUK NATURA DAN KENIKMATAN ..…………...………….....…………...………….....…………...………….....…………Ø

d. JUMLAH YANG MELEBIHI KEWAJARAN YANG DIBAYARKAN KEPADA PEMEGANG SAHAM / PIHAK YANG MEMPUNYAI HUBUNGAN ISTIMEWA SEHUBUNGAN DENGAN PEKERJAAN ..…………...………….....…………...………….....…………...………….....…………...……………..Ø

e. HARTA YANG DIHIBAHKAN, BANTUAN ATAU SUMBANGAN ..…………...………….....…………...………….....…………...………..Ø

f. PAJAK PENGHASILAN ..…………...………….....…………...………….....…………...………….....…………...………….....…………...……..Ø g. GAJI YANG DIBAYARKAN KEPADA ANGGOTA PERSEKUTUAN, FIRMA

ATAU CV YANG MODALNYA TIDAK TERBAGI ATAS SAHAM ..…………...………….....…………...………….....…………...………………Ø

h. SANKSI ADMINISTRASI ..…………...………….....…………...………….....…………...………….....…………...………….....…………...…….Ø

i. SELISIH PENYUSUTAN KOMERSIAL DI ATAS PENYUSUTAN FISKAL ..…………...………….....…………...………….....……………Ø

j. SELISIH AMORTISASI KOMERSIAL DI ATAS AMORTISASI FISKAL ..…………...………….....…………...………….....…………...…..Ø

k. BIAYA YANG DITANGGUHKAN PENGAKUANNYA ..…………...………….....…………...………….....…………...………….....………..Ø

l. PENYESUAIAN FISKAL POSITIF LAINNYA ..…………...………….....…………...………….....…………...………….....…………...………Ø

m. JUMLAH 5a s.d. 5l : ..…………...………….....…………...………….....…………...………….....…………...………….....…………...…………..Ø

PENYESUAIAN FISKAL NEGATIF : a. SELISIH PENYUSUTAN KOMERSIAL DI BAWAH PENYUSUTAN FISKAL ..…………...………….....…………...……………..………..Ø

b. SELISIH AMORTISASI KOMERSIAL DI BAWAH AMORTISASI FISKAL ..…………...………….....…………...………….....…………….Ø

c. PENGHASILAN YANG DITANGGUHKAN PENGAKUANNYA ..…………...………….....…………...………….....…………...……………Ø

d. PENYESUAIAN FISKAL NEGATIF LAINNYA ..…………...………….....…………...………….....…………...………….....…………...…….Ø

e. JUMLAH 6a s.d. 6d ..…………...………….....…………...………….....…………...………….....…………...………….....…………...………………..Ø

FASILITAS PENANAMAN MODAL BERUPA PENGURANGAN PENGHASILAN NETO: TAHUN KE - 7a (Diisi dari Lampiran Khusus 4A Angka 5b) ..…………...………….…………...………………...………….....…………...…….Ø

CATATAN : Pindahkan jumlah Angka 8 ke Formulir 1771 Huruf A Angka 1.

D.1.1.32.31

5d

1f

1g

LAMPIRAN - I

PENGHITUNGAN PENGHASILAN NETO FISKAL

5c

1h

1b

1c

1d

1e

5b

5.

2.

3.

4.4

3

2

URAIAN

s.d.

(1)

IDEN

TITA

S

1a

1.

TAH

UN

PA

JAK

SPT TAHUNAN PAJAK PENGHASILAN WAJIB PAJAK BADAN

(2)

KEMENTERIAN KEUANGAN RIDIREKTORAT JENDERAL PAJAK

NO RUPIAH(3)

FOR

MU

LIR 1771 - I

8.

5f

7.

6.6a

6d

PENGHASILAN NETO FISKAL (3 - 4 + 5m - 6e - 7b) ..…………...………….....…………..

5i

5j

5k

8

5a

6c

7b

5l

5e

5g

5m

5h

6e

6b

2 0 A A

N P W P : NAMA WAJIB PAJAK :

PERIODE PEMBUKUAN :

(1)

1. PEMBELIAN BAHAN/BARANG DAGANGAN

2. GAJI, UPAH, BONUS, GRATIFIKASI,HONORARIUM, THR, DSB

3. BIAYA TRANSPORTASI

4. BIAYA PENYUSUTAN DAN AMORTISASI

5. BIAYA SEWA

6. BIAYA BUNGA PINJAMAN

7. BIAYA SEHUBUNGAN DENGAN JASA

8. BIAYA PIUTANG TAK TERTAGIH

9. BIAYA ROYALTI

10. BIAYA PEMASARAN/PROMOSI

11. BIAYA LAINNYA

12. PERSEDIAAN AWAL

13. PERSEDIAAN AKHIR (-/-)

Catatan :• Nomor 1 untuk Perusahaan Dagang diisi pembelian barang dagangan, untuk perusahaan industri diisi pembelian bahan baku, bahan penolong dan barang jadi.• Nomor 7 termasuk management fee, technical assistance fee, dan jasa lainnya• Nomor 11 diisi dengan total biaya yang tidak tertampung dalam perincian 1 s.d. 10.• Nomor 12 dan 13 untuk perusahaan dagang diisi total persediaan awal dan akhir barang dagangan, untuk perusahaan industri diisi total persediaan

awal/akhir bahan baku/bahan penolong ditambah barang setengah jadi ditambah barang jadi.

D.1.1.32.54

(Rupiah)(Rupiah)

FOR

MU

LIR


LAMPIRAN - IISPT TAHUNAN PAJAK PENGHASILAN WAJIB PAJAK BADAN

PERINCIAN HARGA POKOK PENJUALAN, BIAYA USAHA LAINNYA DAN BIAYA DARI LUAR USAHA SECARA KOMERSIAL

TAH

UN

PA

JAK1771 - II


JUMLAHBIAYA DARI LUAR USAHA

JUMLAH 1 S.D. 12 DIKURANGI 1314

BIAYA USAHA LAINNYAHARGA POKOK PENJUALAN

(3)

PERINCIAN

IDEN

TITA

S

(Rupiah)(4)

NO.

(2)

s.d.

(Rupiah)(6) = (3) + (4) + (5)(5)

2 0 A A


PERIODE PEMBUKUAN :

(1)

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

JUMLAH

Catatan :• Diisi dengan rincian per Bukti Pemotongan / Pemungutan Pajak.• Pindahkan hasil penjumlahan PPh Pasal 22, PPh Pasal 23 dan PPh Pasal 26 Kolom (6) ke Formulir 1771 Huruf C Angka 8.a.

Halaman ke- dari halaman Lampiran-III

D.1.1.32.32

BUKTI PEMOTONGAN / PEMUNGUTAN/SSP/SSPCP

NOMOR

(7) (8)TRANSAKSI (Rupiah)

(4) (5)

YANG DIPOTONG / DIPUNGUT(Rupiah)

(6)

TANGGAL

PEMOTONG / PEMUNGUT PAJAK

NAMA NPWP

PAJAK PENGHASILAN

(2)

TAH

UN

PA

JAK

FOR

MU

LIR 1771 - III

KREDIT PAJAK DALAM NEGERI

NO.

(3)

OBJEK PEMOTONGAN / PEMUNGUTANJENIS PENGHASILAN /

JIKA FORMULIR INI TIDAK MENCUKUPI, DAPAT DIBUAT SENDIRI SESUAI DENGAN BENTUK INI

JML

s.d.

IDEN

TITA

SLAMPIRAN - III

SPT TAHUNAN PAJAK PENGHASILAN WAJIB PAJAK BADANKEMENTERIAN KEUANGAN RI


2 0 A A

N P W P :

NAMA WAJIB PAJAK :

PERIODE PEMBUKUAN :

BAGIAN A : PPh FINAL

BUNGA DEPOSITO / TABUNGAN, DAN DISKONTO SBI / SBN

BUNGA / DISKONTO OBLIGASI

PENGHASILAN PENJUALAN SAHAM YANG DIPERDAGANGKAN DI BURSA EFEK

PENGHASILAN PENJUALAN SAHAM MILIK PERUSAHAAN MODAL VENTURA

PENGHASILAN USAHA PENYALUR / DEALER / AGEN PRODUK BBM

PENGHASILAN PENGALIHAN HAK ATAS TANAH / BANGUNAN

PENGHASILAN PERSEWAAN ATAS TANAH / BANGUNAN IMBALAN JASA KONSTRUKSI : a. PELAKSANA KONSTRUKSI

b. PERENCANA KONSTRUKSI

c. PENGAWAS KONSTRUKSI

PERWAKILAN DAGANG ASING

PELAYARAN / PENERBANGAN ASING

PELAYARAN DALAM NEGERI

PENILAIAN KEMBALI AKTIVA TETAP

TRANSAKSI DERIVATIF YANG

DIPERDAGANGKAN DI BURSA

BAGIAN B : PENGHASILAN YANG TIDAK TERMASUK OBJEK PAJAK

BANTUAN / SUMBANGAN

HIBAH

DIVIDEN / BAGIAN LABA DARI PENYERTAAN MODAL

PADA BADAN USAHA DI INDONESIA (Pasal 4 Ayat (3) Huruf f UU PPh)

IURAN DAN PENGHASILAN TERTENTU YANG DITERIMA DANA PENSIUN

BAGIAN LABA YANG DITERIMA PERUSAHAAN MODAL VENTURA

DARI BADAN PASANGAN USAHA SISA LEBIH YANG DITERIMA ATAU DIPEROLEH BADAN ATAU LEMBAGA NIRLABA YANG BERGERAK DALAM BIDANG PENDIDIKAN DAN/ATAU BIDANG PENELITIAN DAN PENGEMBANGAN, YANG TELAH TERDAFTAR PADA INSTANSI YANG MEMBIDANGINYA, YANG DITANAMKAN KEMBALI DALAM BENTUK SARANA DAN PRASARANA KEGIATAN PENDIDIKAN DAN/ ATAU PENELITIAN DAN PENGEMBANGAN (Pasal 4 Ayat (3) Huruf m UU PPh)

…………………………………………………….…………

Halaman ke- dari halaman Lampiran-IV

D.1.1.32.34

Pindahkan ke Formulir 1771 huruf F angka 15 butir a

JUMLAH BAGIAN A

(1)

JBA

6.

……………………………………………………………14.

JUMLAH BAGIAN B JBB

8.

12.

3.

10.

NO

4.

13.

Pindahkan ke Formulir 1771 huruf F angka 15 butir b

PENGHASILAN BRUTO(Rupiah)

(3)

2.

1.

6.

11.

9.

5.

5.

TAH

UN

PA

JAK


PPh FINAL DAN PENGHASILAN YANG TIDAK TERMASUK OBJEK PAJAK

s.d.

LAMPIRAN - IV

DASAR PENGENAAN PAJAK(Rupiah)

PPh TERUTANG(Rupiah)

(5)(3) (4)

TARIF(%)

FOR

MU

LIR 1771 - IV


IDEN

TITA

S

NO.

(1)

JENIS PENGHASILAN

(2)

2.

1.


(2)

JENIS PENGHASILAN

4.

3.

7.

7.

2 0 A A

• DAFTAR PEMEGANG SAHAM/PEMILIK MODAL DAN JUMLAH DIVIDEN YANG DIBAGIKAN• DAFTAR SUSUNAN PENGURUS DAN KOMISARIS

N P W P :

NAMA WAJIB PAJAK :

PERIODE PEMBUKUAN :

BAGIAN A : DAFTAR PEMEGANG SAHAM / PEMILIK MODAL DAN JUMLAH DIVIDEN YANG DIBAGIKAN

(1)

JBA

BAGIAN B : DAFTAR SUSUNAN PENGURUS DAN KOMISARIS

NO

(1)

Halaman ke- dari halaman Lampiran-V D.1.1.32.35

5.

6.

7.

8.

9.

10.

NPWP JABATAN

1.

2.

3.

4.

NAMA

(2) (4) (5)

ALAMAT

(3)

JUMLAH BAGIAN A

7.

8.

9.

10.

1.

2.

3.

4.

5.

6.

%DIVIDEN(Rupiah)

(2) (3) (4) (5) (6) (7)

NO NAMA ALAMAT NPWPJUMLAH MODAL DISETOR

(Rupiah)

100%


FOR

MU

LIR


s.d.

IDEN

TITA

S

TAH

UN

PA

JAK

LAMPIRAN - V



1771 - V 2 0 A A

• DAFTAR PENYERTAAN MODAL PADA PERUSAHAAN AFILIASI• DAFTAR UTANG DARI PEMEGANG SAHAM DAN/ATAU PERUSAHAAN AFILIASI • DAFTAR PIUTANG KEPADA PEMEGANG SAHAM DAN/ATAU PERUSAHAAN AFILIASI

N P W P :

NAMA WAJIB PAJAK :

PERIODE PEMBUKUAN :

BAGIAN A : DAFTAR PENYERTAAN MODAL PADA PERUSAHAAN AFILIASI

(1)

JBA

BAGIAN B : DAFTAR UTANG DARI PEMEGANG SAHAM DAN/ATAU PERUSAHAAN AFILIASI

(1)

1.

2.

3.

4.

5.

6.

7.

8.

9

10.

11.

12.

13.

BAGIAN C : DAFTAR PIUTANG KEPADA PEMEGANG SAHAM DAN/ATAU PERUSAHAAN AFILIASI

(1)

1.

2.

3.

4.

5.

6.

7.

8.

9

10.

11.

12.

13.

Halaman ke- dari halaman Lampiran-VI

D.1.1.32.36

(Rupiah)JUMLAH PENYERTAAN MODAL

%(5) (6)(3)

(2) (3) (4) (5) (6)

BUNGA/TH%

BUNGA/TH(Rupiah)


NO NAMA N P W P JUMLAH PINJAMAN TAHUN(Rupiah)

%(2) (3) (4) (5) (6)

NO NAMA NPWP JUMLAH PINJAMAN

4.

TAHUN

JUMLAH BAGIAN A

5.

2.

3.

LAMPIRAN - VI

TAH

UN

PA

JAK

FOR

MU

LIR 1771 - VI SPT TAHUNAN PAJAK PENGHASILAN WAJIB PAJAK BADAN



1.

IDEN

TITA

S

s.d.

NO NAMA ALAMAT

(2)

NPWP

(4)

2 0 A

GENERAL INSTRUCTIONS FOR THE COMPLETION

PDF FORM 1771/$

be used for completion income tax annual return form tax year 2010 and onwards.

2. The Tax Return shall be signed by the Taxpayer or his/her authorized proxy/representative and paper should not be fold or rumpled. For printing use the HVS paper size : a. Folio/Government Legal (8,5 X 13 inch); b. Minimum weight of 70 gr

4. Fill the first annexes. Summation and reduction formulas, due to certain sections and

5. <AUTO> sign shows the calculation results automatically. There are times when automatic

pointer to the field where the calculation formula should be run, block numbers there, then

re-checking of results of calculations on this tax return, especially in the field <AUTO> ;

7. SHOW button is used to display calculation formulas in filling this form;

8. RESET button is used to clean up this form from the information that has been loaded previously. After completing the income tax annual return and print it, do not forget to save to another file (Save-as and give it a name that is different from the original file), then use the RESET button to clear the file;

9. HIDE button are used to hide the calculation formulas so that it can be printed blank form if you want to do it manually filling;

10. More complete explanation about completion income tax annual please read the Income Tax Annual Guidebook that his softcopy included in this digital form;

3. To be able to use this form optimally, please use Adobe Reader version 8 or newer and

1. This form is in compliance with the Director General of Taxes Decree No. Per-

recharge by clicking on the Field to be filled. To know which the field that can be filled in, please

34/PJ/2010 about Income Tax Annual Return Form and a General Instructions and can only

click on menu HIGHLIGHTS FIELDS located on the upper right. The Adobe Reader applicationhas been included in the CD or can be downloaded by the Taxpayer for free on the Internet;

calculation is too late to execute, to make sure it runs well, point the cursor

others are available in this form, so that Taxpayer does not need to do a recount;

press DELETE key followed by ENTER. However, Taxpayer are expected to keep doing

6. If additional form of 1771-III/$, 1771-IV/$, 1771-V/$ and 1771-VI/$ is needed more because the information to be loaded more than one page, the forms are now available

to copy and replace filename (rename), for example: 1770-III$-1, 1771-III$-2 etc; in the directory (folder). These files can be reproduced adjust to the needs in a way

11. In the 1771 / $ Form, fill the Rupiah column with exchange value of the US $ column using effective tax rate at the end of tax year except for section F. Final Income Tax and Non Taxable Income that Taxpayer filled from the contents of the 1771-IV / $ Form. The Taxpayer only need to enter a value in a column of U.S. $ and the Rupiah columen value of the conversion amount will automatically appear. In order to run these automated processes, please enter the Exchange Rate Dollar Against Rupiah (USD-IDR) as follow:

• MARK "X" IN THE APPROPRIATE BOX

T I N :

TAXPAYER'S NAME :

BUSINESS CLASIFICATION : KLU :

TELEPHONE NUMBER : ‐ ‐

ACCOUNTING PERIOD : to

APPROVAL TO MAINTAIN BOOKS OF ACCOUNT IN US DOLLAR CURRENCY:

NUMBER : ………………………………………. DATE : STARTING TAXABLE YEAR:

FINANCIAL STATEMENT : AUDITED AUDIT OPINION UNAUDITED

NAME OF PUBLIC ACCOUNTANT FIRM :

T I N OF PUBLIC ACCOUNTANT FIRM :

NAME OF CPA :

T I N OF CPA :

NAME OF TAX CONSULTANT FIRM :

T I N OF TAX CONSULTANT FIRM :

NAME OF TAX CONSULTANT :

T I N OF TAX CONSULTANT :

*) The filling of columns of US Dollars and Rupiahs must be without decimal value (see example in the manual page. 3)

1. FISCAL NET INCOME (Copy from Form 1771-I/$ line 8 column 3) …………………………………

2. FISCAL LOSS CARRIED FORWARD (Copy from Special Attachment 2B Total of column 8) ………………………

3. TAXABLE INCOME (1-2) ……...…..…………………………….

4. INCOME TAX DUE (Choose one of these rates according to the Taxpayer criteria. See manual book)

a. Tax Rate Article 17 paragraph (1) letter b X line 3 …….

b. Tax Rate Article 17 paragraph (2b) X line 3 ……..…………………

c. Tax Rate Article 31E paragraph (1)(see Instructions)

5.

6. TOTAL TAX DUE (4 + 5) …..…………………………………….

7. INCOME TAX BORNED BY THE GOVERNMENT (Foreign Aid Project) …

8. a. DOMESTIC TAX CREDIT (Copy from Form 1771-III/$ Total of column 6) ……….……………..…

b. FOREIGN TAX CREDIT (Copy from Special Attachment 7B Total of column 8) ……….………

c. TOTAL ( 8a + 8b ) ……...……………..….……………………………

9. a. TAX DUE AFTER CREDIT

b. TAX OVERLY WITHHELD

10. PREPAID TAX: a. MONTHLY INSTALLMENT TAX ARTICLE 25….……..……………….

b. NOTICE OF TAX COLLECTION (Principal only) …….….…..……….…

c. TOTAL (10a + 10b)……………………...…………………

11. a. UNDERPAID TAX (INCOME TAX ARTICLE 29)

b. OVERPAID TAX (INCOME TAX ARTICLE 28A)

12. UNDERPAID TAX ON NUMBER 11.a SETTLED ON …………..

13. OVERPAID AMOUNT STATED IN 11.b WOULD BE:

a. REFUNDED b. COMPENSATED WITH OUTSTANDING TAX PAYABLE

Refund for a Taxpayer with Certain Criteria only: Preliminary Refund (Tax Law on Article 17C or 17D )

Rupiah's column should be filled with the conversion number from item in column US$, using tax rate which is valid in the end of taxable yearF.1.1.32.15

FACSIMILE NO:

A. T

AXA

BLE

INC

OM

E

ADJUSTMENT FOR FOREIGN TAX CREDIT REFUNDED THAT HAD BEEN CREDITED IN THE PREVIOUS YEAR'S RETURN (Income Tax Art. 24)

(9 – 10c)

D. I

NC

OM

E TA

X O

VER

/UN

DER

PA

ID

11

10c


FOR

M


11

FOREIGN DOMICILE OF HEAD OFFICE (Permanent Establisment only)

8c

10c

10b

YEAR

9

MONTH

Notes :

DATE

7

8a

8b

9

IDEN

TITY

(1) (2)

10a

C.

TAX

CR

EDIT

S

4

5

10b

6

• FOLLOW INSTRUCTION IN THE MANUAL

• PRINT OR TYPE WITH CAPITAL LETTER OR BLACK INK

(6 – 7 – 8c)

8c

8a

8b

(IDR)(4)(3)

1 1

6

7

10a

B.

INC

OM

E TA

X D

UE

22

5

ATTENTION:

3

4

3

US $

1771/$MINISTRY OF FINANCE OF THE


TAXABLE YEAR

……..AMENDED RETURN

0FOR CORPORATE PERMITTED TO MAINTAIN BOOKS OF ACCOUNT IN ENGLISH LANGUAGE AND US DOLLAR CURRENCY 2

Form 1771/$ Page 2

14 a.

b. FISCAL LOSS CARRIED FORWARD: (From Special Attachment 2B Total of Column 9) .………...

c. TAXABLE INCOME (14a – 14b) …..…………………………………….

d. TAX DUE……………………………………………….. ( Tax Rate from Part B line 4 X 14c)

f. INCOME TAX MUST BE PAID (14d – 14e) ………………………………

g. INCOME TAX ARTICLE 25 : (1/12 X 14f) ………..…….………………

Rupiah's column should be filled with the conversion number from item in Column US$, using tax rate which is valid in the end of taxable year

15 a. FINAL TAX : (From Form 1771-IV/$ Total Part A Column 5) …..……..……Ø

b. NON-TAXABLE INCOME: GROSS INCOME (From Form 1771-IV/$ Total Part B of Column 3) …..……..………...…

16 a.

b.

17 OTHER THAN FORM OF 1771-I/$, 1771-II/$, 1771-III/$, 1771-IV/$, 1771-V/$, AND 1771-VI/$WITH THIS ALSO ATTACHED:

a. THIRD COPY OF TAX PAYMENT RECEIPT OF INCOME TAX ARTICLE 29

b. FINANCIAL STATEMENTS

c. TRANCRIPT OF ELEMENTS CITATION OF FINANCIAL STATEMENT (Special Attachment 8B-1 / 8B-2 / 8B-3 / 8B-4 / 8B-5 / 8B-6/8B-7/8B-8)*

d. DEPRECIATION AND AMORTIZATION TABLES (Special Attachment 1B of the Annual Income Tax Return Manual)*

e. CALCULATION OF FISCAL LOSS CARRIED FORWARD (Special Attachment 2B of Income Tax Return Manual)*

f. INVESTMENT FACILITIES PROVIDED (Special Attachment 4B of the Income Tax Return Manual)

g. LIST OF MAJOR BRANCHES (Special Attachment 5B of the Income Tax Return Manual)

h. THIRD COPY OF PAYMENT RECEIPT OF INCOME TAX ARTICLE 26 PARAGRAPH (4) (For Permanent Establishment only)

i. CALCULATION OF INCOME TAX ART. 26 PARAGRAPH (4) (Permanent Establishment only) (Special Attachment 6B of Income Tax Return Manual)*

j. FOREIGN TAX CREDITS (Special Attachment 7B Income Tax Return Manual)*

k. POWER OF ATTORNEY (If needed)

l.

m.

n.

*

Understanding All The Sanctions Provided by The Law and Regulations, I Hereby Declare that The Information Stated in this Return, IncludingAll Attachments Provided, are True, Complete, Clear, and Under No Circumstances Whatsoever.

a. TAXPAYER b. c. …………………………………., d.

(Place)

SIGNATURE AND COMPANY SEAL:

FULL NAME OF

: e.

T I N : f.

F.1.1.32.15

MANAGEMENT / REPRESENTATIVE

e.

E. M

ON

THLY

INST

ALL

MEN

T O

F A

RT.

25 F

OR

CU

RR

ENT

YEA

R

There is a Transaction in Related Parties and/or with Tax Haven Country Resident(Compulsory to submit Special Attachment 3B, 3B-1, and 3B-2 Manual Book of Annual Return)*

There is not a Transaction in Related Parties and/or with Tax Heaven Country Resident .

All Attachment above can be downloaded on website http://www.pajak.go.id. or take it at the nearest Tax Office.

(1)

INCOME BASE FOR CALCULATION OF MONTHLY TAX INSTALLMENT…………………………………………..

(IDR)

DECLARATION

F. F

INA

L TA

X A

ND

NO

N-

TAXA

BLE

INC

OM

E

15a

H.

ATT

AC

HM

ENTS

date month year

G. S

TATE

MEN

T O

F TR

AN

SAC

TIO

N IN

R

ELA

TED

PA

RTI

ES

AUTHORIZED REPRESENTATIVE

Notes :

14g

14e

14f

WITHHOLDING TAX PAID BASED ON NUMBER 14a………

15b

15a

14g

15b

14d

14c

14b

14a

(4)

14a

14c

14d

14e

14f

14b

(2) (3)US $

T I N :

TAXPAYER'S NAME :

ACCOUNTING PERIOD :

DOMESTIC COMMERCIAL NET INCOME:

a. GROSS INCOME …………..……………………………...…………...…………...… Ø

b. COST OF GOOD SOLD …………...…………...…………...…………...………….. Ø

c. OTHER EXPENSE .…………...…………....…………...…………....…………...… Ø

d. NET INCOME FROM BUSINESS ( 1a - 1b - 1c ) ..…………...………….....……… Ø

e. INCOME FROM SIDE BUSINESS .…………...…………....…………...…………. Ø

f. EXPENSE FROM SIDE BUSINESS.…………...…………....…………...………… Ø

g. NET INCOME FROM SIDE BUSINESS ( 1e - 1f )..…….………….....………….. Ø

h. TOTAL ( 1d + 1g ) : .…………...…………....…………...…………....……… Ø

FOREIGN COMMERCIAL NET INCOME (From Special Attachment 7B Column 5) .…………...…………....…………...………… Ø

TOTAL OF COMMERCIAL NET INCOME (1h + 2) …………………...……………… Ø

INCOME SUBJECT TO FINAL TAX AND NON-TAXABLE INCOME ..…………...………….....…………...………….....…… Ø

POSITIVE FISCAL ADJUSTMENT: a. EXPENSES CHARGED OR INCURRED FOR THE PERSONAL BENEFIT OF

SHAREHOLDERS, PARTNERSHIP OR MEMBERS. ..…………...………….....… Ø

b. FORMATION OR ACCUMULATION OF ALLOWANCES..…………...…………. Ø

c. CONSIDERATION OR REMUNERATION RELATED TO EMPLOYMENT OR

SERVICES GIVEN IN THE FORM OF A BENEFIT IN KIND..…………...……… Ø

d. EXCESSIVE COMPENSATION PAID TO SHAREHOLDERS OR OTHER

ASSOCIATED PARTIES AS A CONSIDERATION OF WORK PERFORMED

……………………………………………………………………………………. Ø

e. GIFTS, AID OR DONATIONS..…………...………….....…………...………….....… Ø

f. INCOME TAX.…………...………….....…………...………….....…………...……… Ø

g. SALARIES PAID TO A MEMBER OF AN ASSOCIATION, FIRMA, OR LIMITED

PARTNERSHIP WHICH CAPITAL DOES NOT CONSIST OF STOCKS..……… Ø

h. ADMINISTRATION PENALTIES..…………...………….....…………...…………... Ø

i. LESS COMMERCIAL DEPRECIATION OVER FISCAL DEPRECIATION ..…… Ø

j. LESS COMMERCIAL AMORTIZATION OVER FISCAL AMORTIZATION ..…… Ø

k. DEFERRED EXPENSES..…………...………….....…………...………….....……… Ø

l. OTHER POSITIVE FISCAL ADJUSTMENTS ..…………...………….....………… Ø

m. TOTAL 5a to 5l : ..…………...………….....…………...………….....……… Ø

NEGATIVE FISCAL ADJUSTMENT: a. LESS COMMERCIAL DEPRECIATION UNDER FISCAL DEPRECIATION..…… Ø

b. LESS COMMERCIAL AMORTIZATION UNDER FISCAL AMORTIZATION..…… Ø

c. DEFERRED INCOME..…………...………….....…………...………….....………… Ø

d. OTHER NEGATIVE FISCAL ADJUSTMENTS..…………...………….....………… Ø

e. TOTAL 6a to 6d ..…………...………….....…………...………….....…………...… Ø

FACILITIES OF INVESTMENT ALLOWANCE …….YEAR 7a (From Special Attachment 4B Line 5b) ..…………...…… Ø

NOTES : Copy Total of Line 8 to Form 1771/$ Letter A Line 1.

D.1.1.32.37

6b

6e

5m

5e

1a

1b

1c

1d

1e

5g

5b

5f

5l

6a

5d

5c

8. FISCAL NET INCOME (3 - 4 + 5m - 6e - 7b) ..…………...………….....………….. 8

5h

5i

5j

6c

6d

5k

7b

1f

3

4

2

5a

4.

2.

3.

7.

6.

5.

1.

1g

1h

(3)

to

IDEN

TITY

DESCRIPTIONS(1) (2)

US$NO

ATTACHMENT - ICORPORATE ANNUAL INCOME TAX RETURN

FOR CORPORATE PERMITTED TO MAINTAIN BOOKS OF ACCOUNT IN ENGLISH LANGUAGE AND US DOLLAR CURRENCY

CALCULATION OF FISCAL NET INCOME TAXA

BLE

YEA

R

FOR

M 1771 - I/$MINISTRY OF FINANCE OF THE



2 0A A


ACCOUNTING PERIOD :

(1)

1. PURCHASE OF MATERIAL/MERCHANDISE

2.

3. TRANSPORTATION EXPENSE

4.

5. RENT EXPENSES

6. INTEREST EXPENSE

7. EXPENSE RELATED TO SERVICE

8. BAD DEBT EXPENSE

9. ROYALTIES EXPENSE

10. MARKETING AND PROMOTION EXPENSE

11. OTHER EXPENSES


13. ENDING INVENTORY (-/-)

Note:• Number 1 for Trading Company fill with inventory, for industry fill with purchase of material, indirect material and finished good.• Number 7 includes management fee, technical assistance fee, and other services • Line 11 includes total expenses not covered in Line 1 to 10•

D.1.1.32.55

1771 - II/$MINISTRY OF FINANCE OF

THE REPUBLIC OF INDONESIA


SALARIES, WAGES, BONUSES, GRATIFICATIONS,HONORARIUM, AND OTHERS

DEPRECIATION AND AMORTIZATION EXPENSE

Line 12 and 13 for trading companies, fill with beginning/ending balances of merchandise inventory, for industrial companies, fill with beginning/ending balances of raw materials, indirect materials, work in process, and finished goods inventory

(4)(3)(US$)

(6) = (3) + (4) + (5)(US$)

(5)

TOTAL

FOR

M

TAXA

BLE

YEA

R

COST OF GOOD SOLD NON-OPERATING EXPENSEOTHER OPERATING EXPENSE


DETAILS OF COST OF GOOD SOLD, OTHER BUSINESS EXPENSE AND COMMERCIAL NON-OPERATING EXPENSE

ATTACHMENT- IICORPORATE ANNUAL INCOME TAX RETURN

14

(2)(US$)

TOTAL OF LINE 1 TO 12 MINUS LINE 13

DETAILS

IDEN

TITY

NO.

to

(US$)

2 0


ACCOUNTING PERIOD :

(1)

1

2

3

4

5

6

7

8

9

10

11

12

13

14

Notes:• Filled with calculation of each Withholding Tax Receipt.• Column (6) US$ filed with convertion value from the number in column (7) Rupiah, using Tax Rates which prevailing at the date of withholding• Copy of Total Income Tax Article 22, Income Tax Article 23 and Income Tax Article 26 column (6) to Form 1771/$ Letter C Line 8.a.

Pages- from page attachment-III

D.1.1.32.39

NAME TIN

WITHHOLDING AGENTNO.

TOTAL TTL

(5)

DIRECTORATE GENERAL OF TAXES FOREIGN TAX CREDIT

INCOME TAX WITHHELD


NUMBER

(2) (3)

WITHHOLDING OBJECT

(US$)TYPES OF INCOME/

(4)

WITHHOLDING RECEIPT/TAX PAYMENT SLIP (SSP/SPPCP)

FOR

MID

ENTI

TY

TAXA

BLE

YEA

R

ATTACHMENT - IIICORPORATE ANNUAL INCOME TAX RETURN

to


1771 - III/$MINISTRY OF FINANCE OF THE REPUBLIC

OF INDONESIA

DATE

(9)(US$) (IDR)

(6) (7) (8)

2 0A A

T I N :

TAXPAYER'S NAME :

ACCOUNTING PERIOD :

PART A: FINAL INCOME TAX

CONSTRUCTION RELATED FEE:

a. CONSTRUCTOR

b. DESIGNER

c. CONSTRUCTION SUPERVISOR

GROSS SALES OF REPRESENTATIVE OFFICE

REVALUATION OF FIXED ASSET

Note : Column (5) US$ should be filled with convertion number of item in column (6) Rupiah, using tax rates prevailing on the date of withholding tax.

PART B : NON-TAXABLE INCOME

b page- page Attachment-IV

D.1.1.32.40

RATE

6.

3.

INCOME FROM SALES VALUE OF VENTURE CAPITAL SHARE

INCOME FROM SALES VALUES OF SHARE TRADED IN STOCK EXCHANGE

INCOME FROM DISTRIBUTOR / DEALER /AGENT OF OIL PRODUCTS

INCOME FROM LEASE/RENT VALUE OF LAND/BUILDING

INCOME FROM TRANSFER VALUE OF RIGHT ON LAND/BUILDING

1771 - IV/$MINISTRY OF FINANCE OF THE



DIVIDEND FROM INVESTMENT/OWNERSHIP OF SHARES OF THE INDONESIAN BUSINESS ENTITIES (Article 4 Paragraph (3) Item f of Income Tax Law)

`

8.

9.

DERIVATIVE TRANSACTION TRADE IN CAPITAL MARKET

11.

GROSS INCOME OF FOREIGN SHIPPING / AIRLINES COMPANY

GROSS INCOME OF DOMESTIC SHIPPING COMPANY

10.

FOR

M

2.

1.

7.

(6)(5)

(IDR)INCOME TAX PAYABLE

TAXA

BLE

YEA

R

(%)NO.

IDEN

TITY

(4)

TAX BASE

to

(1)


FINAL INCOME TAX AND NON-TAXABLE INCOME

INTEREST INCOME ON TIME DEPOSITS/OTHER SAVINGS AND DISCOUNT OF CENTRAL BANK'S SERTIFICATE/SECURITIES STATE

(US$)

(3)

INTEREST/DISCOUNT OF BOND

TYPES OF INCOME

(2)

4.

(1)

TOTAL PART A

NO

1.


Copy of Form 1771/$ letter F line 15 point a

TOTAL PART B TPB

TYPES OF INCOME

TPA

…………………………………………………….…………………………………

EXCESS INCOME RECEIVED BY NONPROFIT AND REGISTERED EDUCATION INSTITUTION OR RESEARCH AND DEVELOPMENT ESTABLISHMENT WHICH ARE REINVESTED IN THE FORM OF FACILITIES AND IN INFRASTUCTURE FOR EDUCATIONAL AND/OR RESEARCH AND DEVELOPMENT ACTIVITIES (Article 4 Paragraph (3) Letter m Income Tax Law)

GROSS INCOME

(US$)

(2)

from

(3)

3.

etc.

2.

Copy of Form 1771/$ letter F line 15 point b

etc.

14.

5.

………………………………………………………

13.

12.

ATTACHMENT - IV CORPORATE ANNUAL INCOME TAX RETURN

(US$)

2 0A A

• LIST OF SHAREHOLDERS/CAPITAL OWNERS AND TOTAL DIVIDENDS DISTRIBUTED• LIST OF DIRECTORS AND COMMISSIONERS

T I N :

TAXPAYER'S NAME :

ACCOUNTING PERIOD :


(3) (4)


(3) (4)


D.1.1.32.41


6.

8.

7.

5.


(6)

9.

100%TPATOTAL PART A

10. etc

etc.

2.

10.

7.

6.

8.

CORPORATE ANNUAL INCOME TAX RETURN

to

TAXA

BLE

YEA

R

(7)(US$)%

DIVIDEND

FOR

M

T I N

(2)

NAME ADDRESS

1771 - V/$MINISTRY OF FINANCE OF THE

REPUBLIC ON INDONESIA

NO

(1)

2.

4.

ATTACHMENT - V

3.

9.

TOTAL PAID IN SHARES(US$)

from

FOR CORPORATE PERMITTED TO MAINTAIN BOOKS IN ACCOUNT IN ENGLISH LANGUAGE AND US DOLLAR CURRENCY

1.

3.

5.

IDEN

TITY

NO

4.

1.

(1)

(5)

POSITIONT I NNAME ADDRESS(2) (5)

2 0 A A

• LIST OF CAPITAL CONTRIBUTION IN AFFILIATION COMPANY• LIST OF PAYABLE FROM SHARESHOLDER AND/OR AFFILIATION COMPANY • LIST OF ACCOUNT RECEIVABLE TO SHARESHOLDER AND/OR AFFILIATION COMPANY

T I N :

TAXPAYER'S NAME :

ACCOUNTING PERIOD :

PART A : LIST OF CAPITAL CONTRIBUTION IN AFFILIATION COMPANY

(1)

5.

etc

PART B : LIST OF ACCOUNT PAYABLE FROM SHARESHOLDER AND/OR AFFILIATION COMPANY

(1)

1.

2.

3.

4.

5.

6.

7.

8.

9

10.

11.

12.

etc

PART C : LIST OF ACCOUNT RECEIVABLE TO SHARESHOLDER AND/OR AFFILIATION COMPANY

(1)

1.

2.

3.

4.

5.

6.

7.

8.

9

10.

11.

12.

etc


D.1.1.32.42

3.

to

NO%

TAXA

BLE

YEA

R

FOR

M

1.

IDEN

TITY


4.

(6)

2.

YEARINTEREST/YR

(US$) %

(2) (3) (4) (5) (6)

IF NEEDED, ADDITIONAL PAGES MAY BE ADDED from


(2) (3) (4)

(US$)

(5) (6)

YEARINTEREST/YR

%

1771 - VI/$MINISTRY OF FINANCE OF THE


(US$)

AMOUNT OF CAPITAL CONTRIBUTIONT I NNAME


ATTACHMENT - VICORPORATE ANNUAL INCOME TAX RETURN


ADDRESS

(2) (3) (4) (5)

TOTAL PART A TPA

2 0 A A

PETUNJUK UMUM PENGISIAN FORMULIR DIGITAL SPT 1771/$

1. Format SPT ini telah sesuai dengan Peraturan Direktur Jenderal Pajak Nomor Per-34/PJ/2010 Tentang Bentuk Formulir Surat Pemberitahuan Tahunan Pajak Penghasilan Wajib Pajak Orang Pribadi Dan Wajib Pajak Badan Beserta Petunjuk Pengisiannya dan hanya dapat digunakan untuk pengisian SPT Tahun Pajak 2010 dan seterusnya

2. SPT hasil pencetakan ini wajib ditanda tangani dan tidak boleh dilipat atau kusut. Untuk pencetakan gunakan hanya kertas HVS berukuran:

Folio/Government Legal (8,5 x 13 inch)

Berat minimal 70 gr

3. SPT Digital ini dapat dibuka dan diisi dengan aplikasi Adobe Reader versi 8 ke atas atau aplikasi pdf reader sejenis dan lakukan pengisian dengan mengklik Field yang akan diisi. Untuk mengetahui Field yang dapat diisi silahkan klik pada menu HIGHLIGHT FIELDS yang terletak pada bagian kanan atas. Sementara untuk aplikasi Adobe Reader telah disertakan dalam CD atau dapat di unduh sendiri oleh Wajib Pajak secara gratis di internet;

4. Isilah dari lampiran-lampirannya terlebih dahulu. Rumus-rumus penjumlahan, pengurangan, kaitan dengan bagian tertentu dan lainnya telah tersedia pada form ini, sehingga WP tidak perlu melakukan penghitungan kembali;

5. Tanda <AUTO> menunjukan hasil perhitungan otomatis. Ada kalanya perhitungan otomatis ini terlambat melakukan eksekusi, untuk memastikan telah berjalan dengan baik, arahkan kursor penunjuk ke sel di mana rumus perhitungan seharusnya berjalan, blok angka yang ada, selanjutnya tekan tombol DELETE dilanjutkan dengan ENTER. Namun demikian Wajib Pajak diharapkan tetap melakukan pengecekan ulang atas hasil perhitungan pada SPT ini terutama pada field <AUTO>;

6. Jika formulir Lampiran 1771-III/$, 1771-IV/$, 1771-V/$ dan 1771-VI/$ diperlukan lebih banyak lagi karena data yang akan diisikan lebih dari 1 (satu) halaman, didalam direktori (folder ) SPT ini telah tersedia file dimaksud. File-file tersebut dapat diperbanyak dengan cara di-copy dan diganti nama filenya (rename), (mis. 1771-III$-1, 1771-III$-2 dst) sesuaikan dengan kebutuhan;

7. Tombol SHOW digunakan untuk menampilkan rumus-rumus perhitungan dalam pengisian SPT secara digital;

8. Tombol RESET digunakan untuk membersihkan file pdf ini dari data yang telah diisikan sebelumnya. Setelah selesai mengisi SPT dan mencetaknya, jangan lupa simpan ke file lain (Save-as dan beri nama yang berbeda dengan file semula), kemudian gunakan tombol RESET untuk membersihkan file;

9. Tombol HIDE digunakan untuk menyembunyikan rumus-rumus perhitungan sehingga Formulir ini dapat dicetak kosong apabila ingin dilakukan pengisian secara manual;

10. Penjelasan lebih lengkap mengenai pengisian SPT Tahunan silahkan baca Buku Petunjuk Pengisian SPT Tahunan yang bentuk softcopy-nya disertakan dalam SPT digital ini;

11. Pada SPT 1771/$ untuk Kolom Rupiah diisi dengan Nilai Konversi dari angka dalam Kolom US$, dengan menggunakan Kurs Pajak yang berlaku pada akhir Tahun Pajak kecuali untuk bagian F. PPh Final dan Penghasilan Bukan Objek Pajak yang WP isi dari Formulir 1771-IV/$. WP hanya memasukkan nilai pada kolom US $ dan secara otomatis akan muncul nilai konversi pada kolom Rupiah. Agar proses otomatis tersebut dapat berjalan silakan masukkan Kurs Dolar Terhadap Rupiah (USD-IDR) pada bagian bawah ini :

PERHATIAN: • SEBELUM MENGISI, BACA DAHULU BUKU PETUNJUK PENGISIAN

• ISI DENGAN HURUF CETAK/DIKETIK DENGAN TINTA HITAM

• BERI TANDA "X" PADA (KOTAK PILIHAN) YANG SESUAI

N P W P :

NAMA WAJIB PAJAK :

JENIS USAHA : KLU :

NO. TELEPON : - NO. FAKS : -

PERIODE PEMBUKUAN : s.d.

NEGARA DOMISILI KANTOR PUSAT (khusus BUT) :

PERSETUJUAN PEMBUKUAN DALAM MATA UANG DOLLAR AS :

NOMOR : ………………………………………. TANGGAL : MULAI TAHUN PAJAK :

PEMBUKUAN / LAPORAN KEUANGAN : DIAUDIT OPINI AKUNTAN TIDAK DIAUDIT

NAMA KANTOR AKUNTAN PUBLIK :

N P W P KANTOR AKUNTAN PUBLIK :

NAMA AKUNTAN PUBLIK :

N P W P AKUNTAN PUBLIK :

NAMA KANTOR KONSULTAN PAJAK :

N P W P KANTOR KONSULTAN PAJAK :

NAMA KONSULTAN PAJAK :

N P W P KONSULTAN PAJAK :

*) Pengisian kolom-kolom yang berisi nilai US$ dan Rupiah harus tanpa nilai desimal (contoh penulisan lihat buku petunjuk hal. 3)

1. PENGHASILAN NETO FISKAL (Diisi dari Formulir 1771-I/$ Nomor 8 Kolom 3) …………………………

2. KOMPENSASI KERUGIAN FISKAL ……………………………………………….

(Diisi dari Lampiran Khusus 2B Jumlah Kolom 8)

3. PENGHASILAN KENA PAJAK (1-2) ……...…..…………………………………….…………………..…………

4. PPh TERUTANG (Pilih salah satu sesuai dengan kriteria Wajib Pajak. Untuk lebih jelasnya, lihat Buku Petunjuk Pengisian SPT)

a. Tarif PPh Ps. 17 Ayat (1) Huruf b X Angka 3 ……..………………..……………

b. Tarif PPh Ps. 17 ayat (2b) X Angka 3 ……..…………………….

c. Tarif PPh Ps. 31E ayat (1) (Lihat Buku Petunjuk)

5. PENGEMBALIAN / PENGURANGAN KREDIT PAJAK LUAR NEGERI (PPh Ps. 24) YANG TELAH DIPERHITUNGKAN TAHUN LALU ……

6. JUMLAH PPh TERUTANG (4 + 5) …..………………………………….…………………..…………

7. PPh DITANGGUNG PEMERINTAH (Proyek Bantuan Luar Negeri) ……..………………..………………..………

8. a. KREDIT PAJAK DALAM NEGERI (Diisi dari Formulir 1771-III/$ Jumlah Kolom 6) ……….……………..…....…………

b. KREDIT PAJAK LUAR NEGERI (Diisi dari Lampiran Khusus 7B jumlah Kolom 8) ……….………………..………

c. JUMLAH ( 8a + 8b ) ……...……………..….……………………………

9. a. PPh YANG HARUS DIBAYAR SENDIRI b. PPh YANG LEBIH DIPOTONG / DIPUNGUT

10. PPh YANG DIBAYAR SENDIRI a. PPh Ps. 25 BULANAN ….……..………………..…………………………………..…………………..…………

b. STP PPh Ps. 25 (Hanya Pokok Pajak) …….….…..……….…………………………………………………

c. JUMLAH (10a + 10b )……………………...…………………

11. a. PPh YANG KURANG DIBAYAR (PPh Ps. 29) b. PPh YANG LEBIH DIBAYAR (PPh Ps. 28A)

12. PPh YANG KURANG DIBAYAR PADA ANGKA 11.a DISETOR TANGGAL ……

13. PPh YANG LEBIH DIBAYAR PADA ANGKA 11.b MOHON :

a. DIRESTITUSIKAN b. DIPERHITUNGKAN DENGAN UTANG PAJAK

Khusus Restitusi untuk Wajib Pajak dengan Kriteria Tertentu : Pengembalian Pendahuluan (Pasal 17C atau Pasal 17D UU KUP)

Kolom Rupiah diisi dengan Nilai Konversi dari angka dalam Kolom US$, dengan menggunakan Kurs Pajak yang berlaku pada akhir Tahun Pajak

F.1.1.32.15

0

3

SPT TAHUNANTAHUN PAJAK

SPT PEMBETULAN

KE- …

PAJAK PENGHASILAN WP BADANBAGI WAJIB PAJAK YANG DIIZINKAN MENYELENGGARAKAN PEMBUKUANDALAM BAHASA INGGRIS DAN MATA UANG DOLLAR AMERIKA SERIKAT

1 1

3


1771/$ 2

5

(RUPIAH)(4)

8a

8b

THN

2

4

(6 – 7 – 8c)

8c

A.

P

EN

GH

AS

ILA

N

KE

NA

PA

JA

KB

. P

Ph

TE

RU

TA

NG

C.

KR

ED

IT P

AJA

K

8a

8b

IDE

NT

ITA

S

(1) (2)

7

FO

RM

UL

IR


10a

US $

2

4

(3)

5

6

9

TGL

10c

10b

(9 – 10c)

BLN

Catatan :

11

D.

PP

h K

UR

AN

G/

LE

BIH

BA

YA

R

8c

6

7

10c

9

11

10a

10b

Formulir 1771/$ Halaman 2(1)

14 a. PENGHASILAN YANG MENJADI DASAR PENGHITUNGAN ANGSURAN ………..………………………………………..…………………..…………

b. KOMPENSASI KERUGIAN FISKAL: (Diisi dari Lampiran Khusus 2B Jumlah Kolom 9) ……....……..……..……..……..……..……..……..……..……..………...

c. PENGHASILAN KENA PAJAK (14a – 14b) …..…………………………………….…………………..………..

d. PPh YANG TERUTANG (Tarif PPh dari Bagian B Nomor 4 X 14c)

e. KREDIT PAJAK TAHUN PAJAK YANG LALU ATAS PENGHASILAN YANG TERMASUK DALAM ANGKA 14a YANG DIPOTONG / DIPUNGUT OLEH PIHAK LAIN …..……..………...…..……..………………..

f. PPh YANG HARUS DIBAYAR SENDIRI (14d – 14e) ………………………………………………..………..

g. PPh PASAL 25 : (1/12 X 14f) ………..…….…………………………………………………..………….

Catatan : Kolom Rupiah diisi dengan Nilai Konversi dari angka dalam Kolom US$, dengan menggunakan Kurs Pajak yang berlaku pada akhir Tahun Pajak

15 a. PPh FINAL : (Diisi dari Formulir 1771-IV/$ Jumlah Bagian A Kolom 5) …..……..………...…..……..………………..

b. PENGHASILAN YANG TIDAK TERMASUK OBJEK PAJAK : PENGHASILAN BRUTO (Diisi dari Formulir 1771-IV/$ Jumlah Bagian B Kolom 3) …..……..………...…..……..………………..

16 a.

b.

17 SELAIN LAMPIRAN-LAMPIRAN 1771-I/$, 1771-II/$, 1771-III/$, 1771-IV/$, 1771-V/$, DAN 1771-VI/$BERSAMA INI DILAMPIRKAN PULA :

a. SURAT SETORAN PAJAK LEMBAR KE-3 PPh PASAL 29

b. LAPORAN KEUANGAN

c. TRANSKRIP KUTIPAN ELEMEN-ELEMEN DARI LAPORAN KEUANGAN (Lampiran Khusus 8B-1 / 8B-2 / 8B-3 / 8B-4 / 8B-5 / 8B-6 / 8B-7 / 8B-8)*

d. DAFTAR PENYUSUTAN DAN AMORTISASI FISKAL (Lampiran Khusus 1B Buku Petunjuk Pengisian SPT)*

e. PERHITUNGAN KOMPENSASI KERUGIAN FISKAL (Lampiran Khusus 2B Buku Petunjuk Pengisian SPT)*

f. DAFTAR FASILITAS PENANAMAN MODAL (Lampiran Khusus 4B Buku Petunjuk Pengisian SPT)*

g. DAFTAR CABANG UTAMA PERUSAHAAN (Lampiran Khusus 5B Buku Petunjuk Pengisian SPT)*

h. SURAT SETORAN PAJAK LEMBAR KE-3 PPh PASAL 26 AYAT (4) (Khusus bagi BUT)

i. PERHITUNGAN PPh PASAL 26 AYAT (4) (Khusus BUT) (Lampiran Khusus 6B Buku Petunjuk Pengisian SPT)*

j. KREDIT PAJAK LUAR NEGERI (Lampiran Khusus 7B Buku Petunjuk Pengisian SPT)*

k. SURAT KUASA KHUSUS (Bila dikuasakan)

l.

m.

n.

*

Dengan menyadari sepenuhnya akan segala akibatnya termasuk sanksi - sanksi sesuai dengan ketentuan perundang-undangan yang berlaku,saya menyatakan bahwa apa yang telah saya beritahukan di atas beserta lampiran-lampirannya adalah benar, lengkap dan jelas.

a. WAJIB PAJAK b. KUASA c. …………………………………., d.(Tempat)

TANDA TANGAN DAN CAP PERUSAHAAN :

NAMA LENGKAP

PENGURUS / KUASA : e.

N P W P : f.

F.1.1.32.15

Wajib Pajak dapat langsung mengunduh dari situs Direktorat Jenderal Pajak dengan alamat http://www.pajak.go.id. atau mengambil di KPP/KP2KP terdekat.

14a

(2) (3)US $

15a

E.

AN

GS

UR

AN

PP

h P

AS

AL

25 T

AH

UN

BE

RJA

LA

N

14a

14c

14d

14e

14f

14b

14g

14c

(4)

14d

(RUPIAH)

14b

14e

14f

14g

PERNYATAAN

F.

PP

h F

INA

L D

AN

PE

NG

HA

SIL

AN

BU

KA

N

OB

JE

K P

AJA

K

15a

H.

LA

MP

IRA

N

tgl bln thn

G.

PE

RN

YA

TA

AN

TR

AN

SA

KS

I D

AL

AM

HU

BU

NG

AN

IS

TIM

EW

A

(Wajib melampirkan Lampiran Khusus 3B, 3B-1, dan 3B-2 Buku Petunjuk Pengisian SPT)*

Tidak Ada Transaksi Dalam Hubungan Istimewa dan/atau Transaksi dengan Pihak yang Merupakan Penduduk Negara Tax Haven

Country .

15b15b

Ada Transaksi Dalam Hubungan Istimewa dan/atau Transaksi dengan Pihak yang Merupakan Penduduk Negara Tax Haven Country.

N P W P :

NAMA WAJIB PAJAK :

PERIODE PEMBUKUAN :

PENGHASILAN NETO KOMERSIAL DALAM NEGERI :

a. PEREDARAN USAHA …………..……………………………...…………...…………...…………...……………...…...………………………….Ø

b. HARGA POKOK PENJUALAN …………...…………...…………...…………...…………...…………...…………...…………...…………...…….Ø

c. BIAYA USAHA LAINNYA .…………...…………....…………...…………....…………...…………....…………...…………....…………...……Ø

d. PENGHASILAN NETO DARI USAHA ( 1a – 1b - 1c ) ..…………...………….....…………...………….....…………...………….....…………...….Ø

e. PENGHASILAN DARI LUAR USAHA .…………...…………....…………...…………....…………...…………....…………...………………….Ø

f. BIAYA DARI LUAR USAHA .…………...…………....…………...…………....…………...…………....…………...…………....…………...……Ø

g. PENGHASILAN NETO DARI LUAR USAHA ( 1e - 1f )..…….………….....…………...…...………..…….....…....…………...……….Ø

h. JUMLAH ( 1d + 1g ) : .…………...…………....…………...…………....…………...…………....…………...…………....…………...……………….Ø PENGHASILAN NETO KOMERSIAL LUAR NEGERI

(Diisi dari Lampiran Khusus 7B Kolom 5) .…………...…………....…………...…………....…………...…………....…………...………………….Ø

JUMLAH PENGHASILAN NETO KOMERSIAL (1h + 2) …………………...…………………...…………………...………………….…………...………Ø

PENGHASILAN YANG DIKENAKAN PPh FINAL

DAN YANG TIDAK TERMASUK OBJEK PAJAK ..…………...………….....…………...………….....…………...………….....…………...…….Ø

PENYESUAIAN FISKAL POSITIF :

a. BIAYA YANG DIBEBANKAN / DIKELUARKAN UNTUK KEPENTINGAN PEMEGANG SAHAM, SEKUTU, ATAU ANGGOTA. ..…………...………….....…………...………….....…………...……………………………Ø

b. PEMBENTUKAN ATAU PEMUPUKAN DANA CADANGAN ..…………...………….....…………...………….....…………...……………..Ø c. PENGGANTIAN ATAU IMBALAN PEKERJAAN ATAU

JASA DALAM BENTUK NATURA DAN KENIKMATAN ..…………...………….....…………...………….....…………...………….....…………Ø

d. JUMLAH YANG MELEBIHI KEWAJARAN YANG DIBAYARKAN KEPADA PEMEGANG SAHAM / PIHAK YANG MEMPUNYAI HUBUNGAN ISTIMEWA SEHUBUNGAN DENGAN PEKERJAAN ..…………...………….....…………...………….....…………...………….....…………...……………..Ø

e. HARTA YANG DIHIBAHKAN, BANTUAN ATAU SUMBANGAN ..…………...………….....…………...………….....…………...………..Ø

f. PAJAK PENGHASILAN ..…………...………….....…………...………….....…………...………….....…………...………….....…………...……..Ø g. GAJI YANG DIBAYARKAN KEPADA ANGGOTA PERSEKUTUAN, FIRMA

ATAU CV YANG MODALNYA TIDAK TERBAGI ATAS SAHAM ..…………...………….....…………...………….....…………...………………Ø

h. SANKSI ADMINISTRASI ..…………...………….....…………...………….....…………...………….....…………...………….....…………...…….Ø

i. SELISIH PENYUSUTAN KOMERSIAL DI ATAS PENYUSUTAN FISKAL ..…………...………….....…………...………….....……………Ø

j. SELISIH AMORTISASI KOMERSIAL DI ATAS AMORTISASI FISKAL ..…………...………….....…………...………….....…………...…..Ø

k. BIAYA YANG DITANGGUHKAN PENGAKUANNYA ..…………...………….....…………...………….....…………...………….....………..Ø

l. PENYESUAIAN FISKAL POSITIF LAINNYA ..…………...………….....…………...………….....…………...………….....…………...………Ø

m. JUMLAH 5a s.d. 5l : ..…………...………….....…………...………….....…………...………….....…………...………….....…………...…………..Ø

PENYESUAIAN FISKAL NEGATIF :

a. SELISIH PENYUSUTAN KOMERSIAL DI BAWAH PENYUSUTAN FISKAL ..…………...………….....…………...……………..………..Ø

b. SELISIH AMORTISASI KOMERSIAL DI BAWAH AMORTISASI FISKAL ..…………...………….....…………...………….....…………….Ø

c. PENGHASILAN YANG DITANGGUHKAN PENGAKUANNYA ..…………...………….....…………...………….....…………...……………Ø

d. PENYESUAIAN FISKAL NEGATIF LAINNYA ..…………...………….....…………...………….....…………...………….....…………...…….Ø

e. JUMLAH 6a s.d. 6d ..…………...………….....…………...………….....…………...………….....…………...………….....…………...………………..Ø

FASILITAS PENANAMAN MODAL BERUPA PENGURANGAN PENGHASILAN NETO :

TAHUN KE - 7a (Diisi dari Lampiran Khusus 4B Angka 5b) ..…………...………….…………...………………...………….....…………...…….Ø

CATATAN : Pindahkan jumlah Angka 8 ke Formulir 1771/$ Huruf A Angka 1.D.1.1.32.37

TA

HU

N P

AJ

AK


FO

RM

UL

IR


BAGI WAJIB PAJAK YANG DIIZINKAN MENYELENGGARAKAN PEMBUKUANDALAM BAHASA INGGRIS DAN MATA UANG DOLLAR AMERIKA SERIKAT

LAMPIRAN - I

1771 - I/$

PENGHITUNGAN PENGHASILAN NETO FISKAL

(3)

s.d.

IDE

NT

ITA

S

URAIAN(1) (2)

US$NO

1.

1g

1h

4.

2.

3.

7.

6.

5.

1e

1f

3

4

2

8. PENGHASILAN NETO FISKAL (3 - 4 + 5m - 6e - 7b) ..…………...………….....…… 8

5h

5i

5j

6c

6d

5k

1a

1b

1c

1d

7b

6b

6e

5m

5e

5g

5a

5c

5b

5f

5l

6a

5d

2 0A A


PERIODE PEMBUKUAN :

(1)

1. PEMBELIAN BAHAN/BARANG DAGANGAN

2. GAJI, UPAH, BONUS, GRATIFIKASI,HONORARIUM, THR, DSB

3. BIAYA TRANSPORTASI

4. BIAYA PENYUSUTAN DAN AMORTISASI

5. BIAYA SEWA

6. BIAYA BUNGA PINJAMAN

7. BIAYA SEHUBUNGAN DENGAN JASA

8. BIAYA PIUTANG TAK TERTAGIH

9. BIAYA ROYALTI

10. BIAYA PEMASARAN/PROMOSI

11. BIAYA LAINNYA

12. PERSEDIAAN AWAL

13. PERSEDIAAN AKHIR (-/-)

Catatan :• Nomor 1 untuk Perusahaan Dagang diisi pembelian barang dagangan, untuk perusahaan industri diisi pembelian bahan baku, bahan penolong dan barang jadi.• Nomor 7 termasuk management fee, technical assistance fee, dan jasa lainnya• Nomor 11 diisi dengan total biaya yang tidak tertampung dalam perincian 1 s.d. 10.• Nomor 12 dan 13 untuk perusahaan dagang diisi total persediaan awal dan akhir barang dagangan, untuk perusahaan industri diisi total persediaan

awal/akhir bahan baku/bahan penolong ditambah barang setengah jadi ditambah barang jadi.

D.1.1.32.55

14

(2)(US$)

JUMLAH 1 S.D. 12 DIKURANGI 13

PERINCIAN

IDE

NT

ITA

S

NO. (US$)

s.d.

(US$)JUMLAH

FO

RM

UL

IR

1771 - II/$KEMENTERIAN KEUANGAN RI

TA

HU

N P

AJ

AK

DALAM BAHASA INGGRIS DAN MATA UANG DOLLAR AMERIKA SERIKAT

HARGA POKOK PENJUALAN

BAGI WAJIB PAJAK YANG DIIZINKAN MENYELENGGARAKAN PEMBUKUAN

LAMPIRAN - II

DIREKTORAT JENDERAL PAJAK PERINCIAN HARGA POKOK PENJUALAN, BIAYA USAHA LAINNYA DAN BIAYA DARI LUAR USAHA SECARA KOMERSIAL

BIAYA DARI LUAR USAHABIAYA USAHA LAINNYA


(4)(3)(US$)

(6) = (3) + (4) + (5)(5)

2 0 A A


PERIODE PEMBUKUAN :

(1)

Catatan :

• Diisi dengan rincian per Bukti Pemotongan / Pemungutan Pajak.• Kolom (6) US$ diisi dengan nilai konversi dari angka dalam Kolom (7) Rupiah, dengan menggunakan Kurs Pajak yang berlaku pada tanggal Pemotongan/Pemungutan• Pindahkan hasil penjumlahan PPh Pasal 22, PPh Pasal 23 dan PPh Pasal 26 Kolom (6) ke Formulir 1771/$ Huruf C Angka 8.a.


D.1.1.32.39

4.

NOMOR

(8)

2.

3.

NO.

(7)

14.

13.

8.

9.

10.

7.

11.

12.

5.

6.

1.


TANGGAL

(9)

IDE

NT

ITA

SSPT TAHUNAN PAJAK PENGHASILAN WAJIB PAJAK BADAN



FO

RM

UL

IR 1771 - III/$KEMENTERIAN KEUANGAN RI


(6)


TA

HU

N P

AJA

K

LAMPIRAN - III


s.d.

NPWP

(2) (3) (4) (5)


NAMA

JUMLAH JML

PAJAK PENGHASILANYANG DIPOTONG / DIPUNGUT

(US$) (Rupiah)


TRANSAKSI (US$)

2 0A A

N P W P :

NAMA WAJIB PAJAK :

PERIODE PEMBUKUAN :

BAGIAN A : PPh FINAL

BUNGA DEPOSITO / TABUNGAN DAN DISKONTO SBI / SBN

BUNGA / DISKONTO OBLIGASI

PENGHASILAN PENJUALAN SAHAM YANG DIPERDAGANGKAN DI BURSA EFEK

PENGHASILAN PENJUALAN SAHAM MILIK PERUSAHAAN MODAL VENTURA PENGHASILAN USAHA PENYALUR / DEALER / AGEN PRODUK BBM

PENGHASILAN PENGALIHAN HAK ATAS TANAH / BANGUNAN

PENGHASILAN PERSEWAAN ATAS TANAH / BANGUNAN IMBALAN JASA KONSTRUKSI : a. PELAKSANA KONSTRUKSI

b. PERENCANA KONSTRUKSI

c. PENGAWAS KONSTRUKSI

PERWAKILAN DAGANG ASING

PELAYARAN / PENERBANGAN ASING

PELAYARAN DALAM NEGERI

PENILAIAN KEMBALI AKTIVA TETAP

TRANSAKSI DERIVATIF YANG

DIPERDAGANGKAN DI BURSA

Catatan : Kolom (5) US$ diisi dengan Nilai Konversi dari angka dalam Kolom (6) Rupiah, dengan menggunakan Kurs Pajak yang berlaku pada tanggal Pemotongan/Pembayaran Pajak.

BAGIAN B : PENGHASILAN YANG TIDAK TERMASUK OBJEK PAJAK

DIVIDEN / BAGIAN LABA DARI PENYERTAAN MODAL

PADA BADAN USAHA DI INDONESIA (Pasal 4 Ayat (3) Huruf f UU PPh)

SISA LEBIH YANG DITERIMA ATAU DIPEROLEH BADAN ATAU LEMBAGA NIRLABA YANG BERGERAK DALAM BIDANG PENDIDIKAN DAN/ATAU BIDANG PENELITIAN DAN PENGEMBANGAN, YANG TELAH TERDAFTAR PADA INSTANSI YANG MEMBIDANGINYA, YANG DITANAMKAN KEMBALI DALAM BENTUK SARANA DAN PRASARANA KEGIATAN PENDIDIKAN DAN/ ATAU PENELITIAN DAN PENGEMBANGAN (Pasal 4 Ayat (3) Huruf m UU PPh)

Halaman ke- dari halaman Lampiran-IV

D.1.1.32.40

(3)

Pindahkan ke Formulir 1771/$ huruf F angka 15 butir a

JUMLAH BAGIAN B JBB

JENIS PENGHASILAN


JBA

PENGHASILAN BRUTO(US$)

(2)(1)

JUMLAH BAGIAN A

NO

………………………………………………………

…………………………………………………….…………………………………

2.

1.

14.

3.

3.

8.

9.

4.

5.


PPh TERUTANG

TA

HU

N P

AJA

K

LAMPIRAN - IV

PPh FINAL DAN PENGHASILAN YANG TIDAK TERMASUK OBJEK PAJAK

s.d.


(US$)(6)

IDE

NT

ITA

S

(4)



JENIS PENGHASILAN

(2)

TARIFDASAR PENGENAAN PAJAK(US$)

(3) (5)(RUPIAH)(%)

(1)

FO

RM

UL

IR

2.

1.

1771 - IV/$


NO.

13.

12.

11.

10.

7.

Pindahkan ke Formulir 1771/$ huruf F angka 15 butir b

6.

2 0 A A

• DAFTAR PEMEGANG SAHAM/PEMILIK MODAL DAN JUMLAH DIVIDEN YANG DIBAGIKAN

• DAFTAR SUSUNAN PENGURUS DAN KOMISARIS

N P W P :

NAMA WAJIB PAJAK :

PERIODE PEMBUKUAN :


(1)

JBA


NO

(1)

Halaman ke- dari halaman Lampiran-V D.1.1.32.41

10.

9.

8.

7.

6.

5.

4.

3.

2.

1.

NAMA ALAMAT NPWP JABATAN

(2) (3) (4) (5)

10.

JUMLAH BAGIAN A

8.

9.

7.

6.

4.

5.

2.

3.

(5)

1.

(2) (3) (4)


(US$)

IDE

NT

ITA

S

s.d.

FO

RM

UL

IR

(US$)%DIVIDEN

TA

HU

N P

AJ

AK


LAMPIRAN - V



1771 - V/$SPT TAHUNAN PAJAK PENGHASILAN WAJIB PAJAK BADAN

(7)


(6)

100%

2 0A A

• DAFTAR PENYERTAAN MODAL PADA PERUSAHAAN AFILIASI

• DAFTAR UTANG DARI PEMEGANG SAHAM DAN/ATAU PERUSAHAAN AFILIASI

• DAFTAR PIUTANG KEPADA PEMEGANG SAHAM DAN/ATAU PERUSAHAAN AFILIASI

N P W P :

NAMA WAJIB PAJAK :

PERIODE PEMBUKUAN :


(1)

JBA


(1)

1.

2.

3.

4.

5.

6.

7.

8.

9

10.

11.

12.

13.


(1)

1.

2.

3.

4.

5.

6.

7.

8.

9

10.

11.

12.

13.


D.1.1.32.42

JUMLAH BAGIAN A

NPWPJUMLAH PENYERTAAN MODAL

(US$)(2) (3) (4) (5) (6)

(2) (3) (4) (5) (6)


NO NAMA N P W P JUMLAH PINJAMAN TAHUN BUNGA/TH(US$) %

TAHUN BUNGA/TH(US$) %

(2) (3) (4) (5) (6)

NO NAMA N P W P JUMLAH PINJAMAN

4.

5.

2.

3.

1.

IDE

NT

ITA

S

s.d.

NO%

NAMA ALAMAT

LAMPIRAN - VI

TA

HU

N P

AJ

AK

FO

RM

UL

IR 1771 - VI/$SPT TAHUNAN PAJAK PENGHASILAN WAJIB PAJAK BADAN




2 0 A A

1A



TANGIBLE ASSETS

Group 1 :

………………………………………………….

Group 2 :

………………………………………………….

Group 3 :

………………………………………………….

Group 4 :

………………………………………………….

BUILDINGS

Permanent

………………………………………………….

Not Permanent :

………………………………………………….

TOTAL DEPRECIATION (For Tax purpose)……………..……………..……………..……………..……………..……………..……………..……………..……………..……………..…………………………………..…………..………………..……………………………..Ø TOTAL COMMERCIAL DEPRECIATION ……………..……………..……………..……………..……………..……………..……………..……………..……………..………………….………………………….………..…………………………………..Ø DIFFERENCE ( COPY TO FORM 1771-I LINE 5 LETTER i OR LINE 6 LETTER a) ……………..……………..……………..……………..……………….………………………..……………………….. Ø INTANGIBLE ASSETS

Group 1 :

………………………………………………….

Group 2 :

………………………………………………….

Group 3 :

………………………………………………….

Group 4 :

………………………………………………….

Other Group

………………………………………………….

TOTAL AMORTIZATION (For Tax purpose)……………..……………..……………..……………..……………..……………..……………..……………..………………………………...…..……………..……………..………………………………………………….. R TOTAL COMMERCIAL AMORTIZATION ……………..……………..……………..……………..……………..……………..……………..……………..……………………….………………...……………..……………..……………………………………..Ø DIFFERENCE ( COPY TO FORM 1771-I LINE 5 LETTER j OR LINE 6 LETTER b) …………..…...……………..……………..……………..…………………………………………………. Ø

…………………………...…,


(……………………………………………………………)

NOTEYEAR OF

(IDR) (IDR) COMMERCIAL VALUEACQUISITION FISCAL (IDR)

SPECIAL ATTACHMENT



GROUP / TYPES OF ASSETS

MONTH/COST OF ACQUISITION

DEPRECIATION/ AMORTIZATION

METHOD

FISCAL DEPRECIATION/AMORTIZATION

IN CURRENT YEARBEGINNING BALANCE

1A

TAHUN PAJAK 2 0

NPWP : NAMA WAJIB PAJAK :

HARTA BERWUJUD

Kelompok 1 :

Kelompok 2 :

Kelompok 3 :

Kelompok 4 :

KELOMPOK BANGUNAN

Permanen

Tidak Permanen :

JUMLAH PENYUSUTAN FISKAL ……………..……………..……………..……………..……………..……………..……………..……………..……………..……………..…………………………………..…………..………………..……………………………..Ø JUMLAH PENYUSUTAN KOMERSIAL ……………..……………..……………..……………..……………..……………..……………..……………..……………..………………….………………………….………..…………………………………..Ø SELISIH PENYUSUTAN ( PINDAHKAN KE FORMULIR 1771-I ANGKA 5 HURUF i ATAU ANGKA 6 HURUF a) ……………..……………..……………..……………..……………….………………………..………………………..Ø HARTA TAK BERWUJUD

Kelompok 1 :

Kelompok 2 :

Kelompok 3 :

Kelompok 4 :

Kelompok Lain-lain

JUMLAH AMORTISASI FISKAL ……………..……………..……………..……………..……………..……………..……………..……………..………………………………...…..……………..……………..………………………………………………….. R JUMLAH AMORTISASI KOMERSIAL ……………..……………..……………..……………..……………..……………..……………..……………..……………………….………………...……………..……………..……………………………………..Ø SELISIH AMORTISASI ( PINDAHKAN KE FORMULIR 1771-I ANGKA 5 HURUF j ATAU ANGKA 6 HURUF b) …………..…...……………..……………..……………..…………………………………………………. Ø

…………………………...…,

WAJIB PAJAK / KUASA

(……………………………………………………………)

CATATANTAHUN PEROLEHAN AWAL TAHUN PENYUSUTAN / AMORTISASI FISKAL TAHUN INI

LAMPIRAN KHUSUS


DAFTAR PENYUSUTAN DAN AMORTISASI FISKAL

KELOMPOK / JENIS HARTA

BULAN / HARGA

FISKAL (RUPIAH)

NILAI SISA BUKU FISKAL

PEROLEHAN

METODE PENYUSUTAN / AMORTISASI

(RUPIAH) (RUPIAH) KOMERSIAL

1B



TANGIBLE ASSETS

Group 1 :

………………………………………………….

Group 2 :

………………………………………………….

Group 3 :

………………………………………………….

Group 4 :

………………………………………………….

BUILDINGS

Permanent

………………………………………………….

Not Permanent :

………………………………………………….

TOTAL DEPRECIATION (For Tax purpose)……………..……………..……………..……………..……………..……………..……………..……………..……………..……………..…………………………………..…………..………………..……………………………..Ø TOTAL COMMERCIAL DEPRECIATION ……………..……………..……………..……………..……………..……………..……………..……………..……………..………………….………………………….………..…………………………………..Ø DIFFERENCE ( COPY TO FORM 1771-I LINE 5 LETTER i OR LINE 6 LETTER a) ……………..……………..……………..……………..……………….………………………..……………………….. Ø INTANGIBLE ASSETS

Group 1 :

………………………………………………….

Group 2 :

………………………………………………….

Group 3 :

………………………………………………….

Group 4 :

………………………………………………….

Other Group

………………………………………………….

TOTAL AMORTIZATION (For Tax purpose)……………..……………..……………..……………..……………..……………..……………..……………..………………………………...…..……………..……………..………………………………………………….. R TOTAL COMMERCIAL AMORTIZATION ……………..……………..……………..……………..……………..……………..……………..……………..……………………….………………...……………..……………..……………………………………..Ø DIFFERENCE ( COPY TO FORM 1771-I LINE 5 LETTER j OR LINE 6 LETTER b) …………..…...……………..……………..……………..…………………………………………………. Ø

…………………………...…,


(……………………………………………………………)

NOTEYEAR OF

ACQUISITION (US$) (US$) COMMERCIAL VALUE FISCAL (US$)

SPECIAL ATTACHMENT



GROUP / TYPES OF ASSETS

MONTH/COST OF ACQUISITION BEGINNING BALANCE

DEPRECIATION/ AMORTIZATION

METHOD

FISCAL

DEPRECIATION/AMORTIZATION IN

CURRENT YEAR

FOR CORPORATION PERMITTED TO MAINTAIN BOOKS OF ACCOUNT IN

ENGLISH LANGUAGE AND US DOLLAR CURRENCY

1B

TAHUN PAJAK 2 0

NPWP : NAMA WAJIB PAJAK :

HARTA BERWUJUD

Kelompok 1 :

………………………………………………….

Kelompok 2 :

………………………………………………….

Kelompok 3 :

………………………………………………….

Kelompok 4 :

………………………………………………….

KELOMPOK BANGUNAN

Permanen

………………………………………………….

Tidak Permanen :

………………………………………………….

JUMLAH PENYUSUTAN FISKAL ……………..……………..……………..……………..……………..……………..……………..……………..……………..……………..…………………………………..…………..………………..……………………………..Ø JUMLAH PENYUSUTAN KOMERSIAL ……………..……………..……………..……………..……………..……………..……………..……………..……………..………………….………………………….………..…………………………………..Ø SELISIH PENYUSUTAN ( PINDAHKAN KE FORMULIR 1771-I /$ ANGKA 5 HURUF i ATAU ANGKA 6 HURUF a) ……………..……………..……………..……………..……………….………………………..………………………..Ø HARTA TAK BERWUJUD

Kelompok 1 :

………………………………………………….

Kelompok 2 :

………………………………………………….

Kelompok 3 :

………………………………………………….

Kelompok 4 :

………………………………………………….

Kelompok Lain-lain

………………………………………………….

JUMLAH AMORTISASI FISKAL ……………..……………..……………..……………..……………..……………..……………..……………..………………………………...…..……………..……………..………………………………………………….. R JUMLAH AMORTISASI KOMERSIAL ……………..……………..……………..……………..……………..……………..……………..……………..……………………….………………...……………..……………..……………………………………..Ø SELISIH AMORTISASI ( PINDAHKAN KE FORMULIR 1771-I/$ ANGKA 5 HURUF j ATAU ANGKA 6 HURUF b) …………..…...……………..……………..……………..…………………………………………………. Ø

…………………………...…,

WAJIB PAJAK / KUASA

(US$)

BULAN / HARGA NILAI SISA BUKU FISKAL

(……………………………………………………………)

PENYUSUTAN / AMORTISASI

CATATANTAHUN PEROLEHAN AWAL TAHUN

(US$) (US$) KOMERSIAL FISKAL

LAMPIRAN KHUSUS

SPT TAHUNAN PAJAK PENGHASILAN WAJIB PAJAK BADANBAGI WAJIB PAJAK YANG DIIZINKAN MENYELENGGARAKAN PEMBUKUAN

DALAM MATA UANG DOLLAR AMERIKA SERIKAT

DAFTAR PENYUSUTAN DAN AMORTISASI FISKAL

KELOMPOK / JENIS HARTA PENYUSUTAN / AMORTISASI FISKAL TAHUN INI

PEROLEHAN

METODE

2A

TAXABLE YEAR 2 0




(1)

1

2

3

4

5

etc

NOTE: …………………………...…,



SPECIAL ATTACHMENT



NO


YEAR IDR(THIS TAXABLE YEAR) (CURRENT TAXABLE YEAR)

(IDR) (IDR) (IDR) (IDR) IDR *) IDR**)

(2) (3) (4) (5) (6) (7) (8) (9)

TOTAL

(……………………………………………………………)

TTL

2A

TAHUN PAJAK 2 0

UNTUK TAHUN PAJAK DAN TAHUN PAJAK BERJALAN


TH. TH. TH. TH. TH. TH.

(1)

1

2

3

4

5

dst

J U M L A H

CATATAN : …………………………...…,

*) PINDAHKAN JUMLAH KOLOM INI KE FORMULIR 1771 HURUF A ANGKA 2

**) PINDAHKAN JUMLAH KOLOM INI KE FORMULIR 1771 HURUF E ANGKA 14 BUTIR b WAJIB PAJAK / KUASA

(……………………………………………………………)

JML

(8) (9)(2) (3) (4) (5) (6) (7)

(TAHUN BERJALAN)

(RUPIAH) (RUPIAH) (RUPIAH) (RUPIAH) RUPIAH *) RUPIAH **)

LAMPIRAN KHUSUS


PERHITUNGAN KOMPENSASI KERUGIAN FISKAL

NO

KERUGIAN DAN PENGHASILAN NETO FISKAL KOMPENSASI KERUGIAN FISKAL

TAHUN RUPIAH(TAHUN PAJAK INI)

2B

TAXABLE YEAR 2 0




(1)

1

2

3

4

5

etc

NOTE: …………………………...…,



SPECIAL ATTACHMENT



NO


YEAR US$(THIS TAXABLE YEAR) (CURRENT TAXABLE YEAR)

(US$) (US$) (US$) (US$) US$*) US$**)

(2) (3) (4) (5) (6) (7) (8) (9)

FOR CORPORATION PERMITTED TO MAINTAIN BOOKS OF ACCOUNT IN ENGLISH

LANGUAGE AND US DOLLAR CURRENCY

(……………………………………………………………)

TOTAL TTL

2B

TAHUN PAJAK 2 0




(1)

1

2

3

4

5

J U M L A H

CATATAN : …………………………...…,

*) PINDAHKAN JUMLAH KOLOM INI KE FORMULIR 1771 /$ HURUF A ANGKA 2

**) PINDAHKAN JUMLAH KOLOM INI KE FORMULIR 1771 /$ HURUF E ANGKA 14 BUTIR b WAJIB PAJAK / KUASA

LAMPIRAN KHUSUS




NO


TAHUN US$(TAHUN PAJAK INI) (TAHUN BERJALAN)

(US$) (US$) (US$) (US$) US$ *) US$ **)

(2) (3) (4) (5) (6) (7) (8) (9)

(……………………………………………………………)

JML

3A

FOR TAXABLE YEAR

T I N:

TAXPAYER'S NAME :


1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4


a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

………………………,


5

1

2

3

4

5


SPECIAL ATTACHMENT

NameNo.

Name No.

Types of Relationship with

Taxpayer

1

2

3

4



Types of Transaction Transaction's Value

(……………………………………………………………)


Determination of Price Method

shall be used Determination of Methods

3A

TAHUN PAJAK

NPWP:

Nama :

I DAFTAR PIHAK YANG MEMILIKI HUBUNGAN ISTIMEWA

No

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

II RINCIAN TRANSAKSI DENGAN PIHAK YANG MEMILIKI HUBUNGAN ISTIMEWA

No

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

JIKA FORMULIR INI TIDAK MENCUKUPI, DAPAT DIBUAT SENDIRI SESUAI DENGAN BENTUK INI ………………………,

WAJIB PAJAK / KUASA


LAMPIRAN KHUSUS

(……………………………………………………………)

4

5

2

3

Nama Mitra Transaksi Jenis Transaksi Nilai TransaksiMetode Penetapan Harga yang

digunakanAlasan Penggunaan Metode

1

4

5

2

3

Nama Alamat NPWP/ Tax Identification Number Kegiatan UsahaBentuk Hubungan dengan Wajib

Pajak

PERNYATAAN TRANSAKSI DENGAN PIHAK YANG MEMILIKI HUBUNGAN ISTIMEWA

1

3B

FOR TAXABLE YEAR

T I N:

TAXPAYER'S NAME :


1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4


a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

………………………,


4

5

SPECIAL ATTACHMENT






1

2

3

4

No. Name Types of Transaction Transaction's Value

5



1

2

3


(……………………………………………………………)

3B

NPWP:

Nama :


No

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4


No

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

………………………,


WAJIB PAJAK / KUASA

(……………………………………………………………)

4

5

2

3

Metode Penetapan Harga yang


1

5

Nama Mitra Transaksi Jenis Transaksi Nilai Transaksi

3

4

1

2


Pajak

LAMPIRAN KHUSUS




TAHUN PAJAK


3A-1

FOR TAXABLE YEAR

T I N :


Yes


Yes


Yes


Yes

…………………….., …………………………………


____________________________________________

3


No





No







Concerning of Comparation Analysis Result Notes



No




Corcerning of company's description in detail




SPECIAL ATTACHMENT




No


1


3A-1

TAHUN PAJAK

N P W P :

NAMA WAJIB PAJAK / BUT :

Ya

Mengenai Transaksi

Ya

Transaksi Wajib Pajak dengan perusahaan yang mempunyai hubungan istimewa.

-

-

Ya

Strategi bisnis Wajib Pajak pada saat melakukan transaksi affiliasi.

Bahwasannya kami telah membuat catatan tentang :

Ya

…………………….., …………………………………

WAJIB PAJAK/KUASA

____________________________________________

Metodologi penentuan harga yang diterapkan oleh Wajib Pajak, yang menunjukkan bagaimana harga yang wajar diperoleh, dan alasan metode tersebut dipilih

dibandingkan dengan metode-metode lainnya.

Data pembanding yang digunakan oleh Wajib Pajak untuk menentukan harga transfer.

Aplikasi metodologi penentuan harga transfer dan penggunaan data pembanding dalam penentuan harga transfer.

Analisis fungsional yang menjadi dasar pertimbangan dilakukannya transaksi antara Wajib Pajak dengan perusahaan yang mempunyai hubungan istimewa,

semua risiko-risiko diasumsikan dan aktiva-aktiva digunakan dalam transaksi tersebut.

Kondisi-kondisi ekonomi pada saat terjadinya transaksi.

Syarat-syarat transaksi-transaksi (terms of transactions ), termasuk juga perjanjian sesuai kontrak antara Wajib Pajak dengan pihak-pihak yang masih

mempunyai hubungan istimewa di luar negeri.

Transaksi Wajib Pajak dengan perusahaan yang tidak dipengaruhi oleh hubungan istimewa atau informasi mengenai transaksi pembanding.

4 Mengenai Catatan Mengenai Penentuan Harga Wajar

Tidak

3 Mengenai Catatan Hasil Analisis Kesebandingan


Tidak

Karakteristik dari produk (barang, jasa, pinjaman, instrumen keuangan, dan lain-lain) yang ditransaksikan.

Aspek-aspek operasional kegiatan usaha Wajib Pajak termasuk rincian fungsi-fungsi yang diselenggarakan oleh unit-unit yang berada dalam organisasi

perusahaan Wajib Pajak.

Gambaran Lingkungan Usaha Secara Rinci.

2


Tidak

Tidak

Struktur kepemilikan yang menunjukkan keterkaitan antara semua perusahaan dalam satu kelompok perusahaan multinasional.

Struktur organisasi perusahaan Wajib Pajak.

Berikut catatan-catatan khusus yang kami buat untuk mendukung bahwa transaksi yang dilakukan dengan pihak yang mempunyai hubungan istimewa telah sesuai dengan

prinsip kewajaran (arm’s length principle ) dan kelaziman.

1 Mengenai Gambaran Perusahaan Secara Rinci Bahwasannya kami telah membuat catatan tentang :

I DOKUMENTASI PENETAPAN HARGA WAJAR TRANSAKSI

Dalam hal Wajib Pajak bertindak sebagai pihak yang menjual, menyerahkan atau meminjamkan dalam transaksi-transaksi sebagaimana disebutkan

di atas, kami telah menyelenggarakan catatan sebagai berikut:

Kebijakan penentuan harga dan daftar harga selama 5 (lima) tahun terakhir

Rincian biaya pabrikasi atau harga perolehan atau biaya penyiapan jasa.

LAMPIRAN KHUSUS


PERNYATAAN TRANSAKSI DALAM HUBUNGAN ISTIMEWA

3B-1

FOR TAXABLE YEAR

T I N :


Yes


Yes


Yes


Yes

…………………….., …………………………………


____________________________________________

SPECIAL ATTACHMENT

ANNUAL INCOME TAX RETURN FOR CORPORATE FOR CORPORATION PERMITTED TO MAINTAIN BOOKS OF ACCOUNT IN ENGLISH



I DOCUMENTATION OF ARM'S LENGTH TRANSACTION DETERMINATIONThese are some particular notes that we made to support the fact that transactions that have been made with related parties are in accordance with the arm's length principle and the common practice.

1 Corcerning of company's description in detailThat we have made note about :

No






No






3 Concerning of Comparation Analysis Result NotesThat we have made note about :

No


No








3B-1

N P W P :


Ya

Mengenai Transaksi

Ya

Transaksi Wajib Pajak dengan perusahaan yang mempunyai hubungan istimewa.

-

-

Ya

Strategi bisnis Wajib Pajak pada saat melakukan transaksi affiliasi.


Ya

…………………….., …………………………………

WAJIB PAJAK/KUASA

____________________________________________

LAMPIRAN KHUSUS



TAHUN PAJAK

PERNYATAAN TRANSAKSI DALAM HUBUNGAN ISTIMEWA

I DOKUMENTASI PENETAPAN HARGA WAJAR TRANSAKSI

Berikut catatan-catatan khusus yang kami buat untuk mendukung bahwa transaksi yang dilakukan dengan pihak yang mempunyai hubungan istimewa telah sesuai dengan

prinsip kewajaran (arm’s length principle ) dan kelaziman.

1 Mengenai Gambaran Perusahaan Secara Rinci Bahwasannya kami telah membuat catatan tentang :

Tidak

Struktur kepemilikan yang menunjukkan keterkaitan antara semua perusahaan dalam satu kelompok perusahaan multinasional.

Struktur organisasi perusahaan Wajib Pajak.

Aspek-aspek operasional kegiatan usaha Wajib Pajak termasuk rincian fungsi-fungsi yang diselenggarakan oleh unit-unit yang berada dalam organisasi

perusahaan Wajib Pajak.

Gambaran Lingkungan Usaha Secara Rinci.

2


Tidak

4 Mengenai Catatan Mengenai Penentuan Harga Wajar

Transaksi Wajib Pajak dengan perusahaan yang tidak dipengaruhi oleh hubungan istimewa atau informasi mengenai transaksi pembanding.

3 Mengenai Catatan Hasil Analisis Kesebandingan


Tidak

Dalam hal Wajib Pajak bertindak sebagai pihak yang menjual, menyerahkan atau meminjamkan dalam transaksi-transaksi sebagaimana disebutkan

di atas, kami telah menyelenggarakan catatan sebagai berikut:

Kebijakan penentuan harga dan daftar harga selama 5 (lima) tahun terakhir

Rincian biaya pabrikasi atau harga perolehan atau biaya penyiapan jasa.

Tidak

Metodologi penentuan harga yang diterapkan oleh Wajib Pajak, yang menunjukkan bagaimana harga yang wajar diperoleh, dan alasan metode tersebut dipilih

dibandingkan dengan metode-metode lainnya.

Data pembanding yang digunakan oleh Wajib Pajak untuk menentukan harga transfer.

Aplikasi metodologi penentuan harga transfer dan penggunaan data pembanding dalam penentuan harga transfer.

Karakteristik dari produk (barang, jasa, pinjaman, instrumen keuangan, dan lain-lain) yang ditransaksikan.

Analisis fungsional yang menjadi dasar pertimbangan dilakukannya transaksi antara Wajib Pajak dengan perusahaan yang mempunyai hubungan istimewa,

semua risiko-risiko diasumsikan dan aktiva-aktiva digunakan dalam transaksi tersebut.

Kondisi-kondisi ekonomi pada saat terjadinya transaksi.

Syarat-syarat transaksi-transaksi (terms of transactions ), termasuk juga perjanjian sesuai kontrak antara Wajib Pajak dengan pihak-pihak yang masih

mempunyai hubungan istimewa di luar negeri.

3A-2

FOR TAXABLE YEAR

TIN:

TAXPAYER'S NAME :

I

No

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g


YES NO

……………………….., ………………………


( ………………………… )




5

4

3

2

1



SPECIAL ATTACHMENT

3A-2

TAHUN PAJAK

NPWP:

Nama :

I

No

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

II PENETAPAN NILAI TRANSAKSI DI ATAS, DITETAPKAN DENGAN MENGGUNAKAN PRINSIP KEWAJARAN DAN KELAZIMAN USAHA

Ya Tidak

……………………….., ………………………

WAJIB PAJAK / KUASA

( ………………………… )



PERNYATAAN TRANSAKSI DENGAN PIHAK YANG MERUPAKAN PENDUDUK NEGARA TAX HAVEN COUNTRY

5

4

3

2

1

DALAM HAL WAJIB PAJAK DALAM TAHUN PAJAK INI MELAKUKAN TRANSAKSI DENGAN PIHAK-PIHAK YANG MERUPAKAN PENDUDUK NEGARA TAX HAVEN COUNTRY

Nama Mitra Transaksi Jenis Transaksi Negara Nilai Transaksi

LAMPIRAN KHUSUS

3B-2

FOR TAXABLE YEAR

TIN:

TAXPAYER'S NAME :

I

No

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g


YES NO

……………………….., ………………………


( ………………………… )


5

4

3

2

1




SPECIAL ATTACHMENT


FOR CORPORATION PERMITTED TO MAINTAIN BOOKS OF

ACCOUNT IN ENGLISH LANGUAGE AND US DOLLAR CURRENCY

3B-2

TAHUN PAJAK

NPWP:

Nama :

I

No

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g


Ya Tidak

……………………….., ………………………

WAJIB PAJAK / KUASA

( ………………………… )


4

5

3

2



1

LAMPIRAN KHUSUS





4A

FOR TAXABLE YEAR

T I N :

TAXPAYER'S NAME :



1 NUMBER : ……………………………………………………….. 1 NUMBER : ………………………………………………………..

2 DATE : ……………………………………………………….. 2 DATE : ………………………………………………………..



3. IN IDR. : 2a3

4. TOTAL IDR. : 2a4


c. …………………………………………………………………………………………………………………………





a. THIS YEAR : IDR a

b. UP TO THIS YEAR : IDR b

FACILITIES OF INVESTMENT ALLOWANCE : YEAR a b IDR. **)


NOTE:

*) ……………………………,


LINE 7 COLUMN (3)

5.

(……………………………………………………………)



5

3.

10 % TAX ON DIVIDENDS PAID TO FOREIGN SHAREHOLDERS


1.

2.



4A

TAHUN PAJAK

N P W P :

NAMA WAJIB PAJAK :

DALAM HAL PERUSAHAAN MENDAPAT FASILITAS PERPAJAKAN DALAM RANGKA PENANAMAN MODAL, JELASKAN :

a. SURAT PERSETUJUAN KETUA BKPM b. SURAT KEPUTUSAN MENTERI KEUANGAN

1 NOMOR : ……………………………………………………….. 1 NOMOR : ………………………………………………………..

2 TANGGAL : ……………………………………………………….. 2 TANGGAL : ………………………………………………………..

a. JUMLAH PENANAMAN MODAL YANG DISETUJUI : 1. DALAM VALAS : 2a1

2. EQUIVALEN Rp. : 2a2 *)

3. DALAM Rp. : 2a3

4. JUMLAH Rp. : 2a4

b. PENANAMAN MODAL : 1 BARU 2 PERLUASAN

c. DI BIDANG DAN/ ATAU DAERAH : …………………………………………………………………………………………………………………………

d. FASILITAS YANG DIBERIKAN : 1 PENGURANGAN PENGHASILAN NETO

2 PENYUSUTAN / AMORTISASI DIPERCEPAT

3 KOMPENSASI KERUGIAN 4 TAHUN

PENGURANGAN 50 % TARIF PPh ATAS DIVIDEN YANG DIBAYARKAN KEPADA PEMEGANG SAHAM LUAR NEGERI

REALISASI PENANAMAN MODAL

a. TAHUN INI : Rp. a

b. S.D TAHUN INI : Rp. b

SAAT MULAI BERPRODUKSI KOMERSIAL (SMBK) TANGGAL :

FASILITAS PENGURANGAN PENGHASILAN NETO : TAHUN KE a b Rp. **)

(5% X REALISASI PENANAMAN MODAL S.D. SMBK)

CATATAN :

*) DENGAN KURS YANG SEBENARNYA BERLAKU PADA ……………………………,

SAAT TRANSFER DANA KE REKENING PERUSAHAAN

**) PINDAHKAN JUMLAH ANGKA 5 b KE FORMULIR 1771-I WAJIB PAJAK / KUASA

ANGKA 7 KOLOM (3)

5.

(……………………………………………………………)

4.

5

3.

1.

2.

LAMPIRAN KHUSUS


2 0

DAFTAR FASILITAS PENANAMAN MODAL

4B

FOR TAXABLE YEAR

T I N :

TAXPAYER'S NAME :



1 NUMBER : ……………………………………………………….. 1 NUMBER : ………………………………………………………..

2 DATE : ……………………………………………………….. 2 DATE : ………………………………………………………..

a. AMOUNT OF INVESTMENT APPROVED: 1. IN US $ : 2a1

2. IN FOREX :

OTHERS US $

3. EQUIVALENT US $ : 2a3 *)

4. IN IDR 2a4

3. EQUIVALENT US $ : 2a5 *)

4. TOTAL US$. : 2a6


c. …………………………………………………………………………………………………………………………





a. THIS YEAR : US$. a

b. UP TO THIS YEAR : US$. b

FACILITIES OF INVESTMENT ALLOWANCE : YEAR a b US$. **)


NOTE:

*) ……………………………,


LINE 7 COLUMN (3)

5.


(……………………………………………………………)


3.



5 10 % TAX ON DIVIDENDS PAID TO FOREIGN SHAREHOLDERS

1.

2.

2a2



4B

TAHUN PAJAK

N P W P :

NAMA WAJIB PAJAK :

DALAM HAL PERUSAHAAN MENDAPAT FASILITAS PERPAJAKAN DALAM RANGKA PENANAMAN MODAL, JELASKAN :

a. SURAT PERSETUJUAN KETUA BKPM b. SURAT KEPUTUSAN MENTERI KEUANGAN

1 NOMOR : ……………………………………………………….. 1 NOMOR : ………………………………………………………..

2 TANGGAL : ……………………………………………………….. 2 TANGGAL : ………………………………………………………..

a. JUMLAH PENANAMAN MODAL YANG DISETUJUI : 1. DALAM US $ : 2a1

2. DALAM VALAS

SELAIN US $ : 2a2

3. EQUIVALEN US$ : 2a3 *)

4. DALAM RUPIAH : 2a4

5. EQUIVALEN US$ : 2a5 *)

6. JUMLAH US $ : 2a6

b. PENANAMAN MODAL : 1 BARU 2 PERLUASAN

c. DI BIDANG DAN/ATAU DIDAERAH : …………………………………………………………………………………………………………………………

d. FASILITAS YANG DIBERIKAN : 1 PENGURANGAN PENGHASILAN NETO

2 PENYUSUTAN / AMORTISASI DIPERCEPAT

3 KOMPENSASI KERUGIAN 4 TAHUN

PENGURANGAN 50 % TARIF PPh ATAS DIVIDEN YANG DIBAYARKAN KEPADA PEMEGANG SAHAM LUAR NEGERI

REALISASI PENANAMAN MODAL

a. TAHUN INI : US$ 3a

b. S.D TAHUN INI : US$ 3b

SAAT MULAI BERPRODUKSI KOMERSIAL (SMBK) TANGGAL :

FASILITAS PENGURANGAN PENGHASILAN NETO : TAHUN KE a b US$ **)

(5% X REALISASI PENANAMAN MODAL S.D. SMBK)

CATATAN :

*) DENGAN KURS YANG SEBENARNYA BERLAKU PADA ……………………………,

SAAT TRANSFER DANA KE REKENING PERUSAHAAN

**) PINDAHKAN JUMLAH ANGKA 5b KE FORMULIR 1771-I/$ WAJIB PAJAK / KUASA

ANGKA 7 KOLOM (3)

5.

(……………………………………………………………)

3.

4.

5

1.

2.

DAFTAR FASILITAS PENANAMAN MODAL

LAMPIRAN KHUSUS



2 0

5A

FOR TAXABLE YEAR

T I N :

TAXPAYER'S NAME :

NOTE: ……………………………,






BRANCHES

(1) (2) (3) (4)

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

etc.

(……………………………………………………………)

24

25

5A

TAHUN PAJAK

N P W P :

NAMA WAJIB PAJAK :

CATATAN : ……………………………,

APABILA TIDAK MENCUKUPI DAPAT DIGANDAKAN

WAJIB PAJAK / KUASA

dst.

(……………………………………………………………)

24

25

22

23

20

21

18

19

16

17

14

15

12

13

10

11

8

9

6

7

4

5

2

3

(1) (2) (3) (4)

1

NO ALAMAT CABANG UTAMA NPWP LOKASI

JUMLAH

CABANG

PEMBANTU

LAMPIRAN KHUSUS


2 0DAFTAR CABANG UTAMA PERUSAHAAN

5B

FOR TAXABLE YEAR

T I N :

TAXPAYER'S NAME :

NOTE: ……………………………,







BRANCHES

(1) (2) (3) (4)

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

(……………………………………………………………)

19

20

5B

TAHUN PAJAK

N P W P :

NAMA WAJIB PAJAK :

CATATAN : ……………………………,


WAJIB PAJAK / KUASA

LAMPIRAN KHUSUS



2 0

DAFTAR CABANG UTAMA PERUSAHAAN


JUMLAH

CABANG

PEMBANTU

(1) (2) (3) (4)

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

(……………………………………………………………)

6A

FOR TAXABLE YEAR

T I N :

:



a. POSITIVE : IDR.

b. NEGATIVE : IDR.

c. TOTAL (a – b) : …………………………………………………………………









………………………………………………………………………………………

TIN : e

ADDRESS : f ………………………………………………………………………………………

………………………………………………………………………………………


NOTE: ……………………,



(……………………………………………………………)

5.

6.

3.

4.

IDR

1.

2.




6A

TAHUN PAJAK

N P W P :


PENGHASILAN NETO KOMERSIAL : ………………………………………………………

(BERDASARKAN LAPORAN KEUANGAN)

PENYESUAIAN FISKAL :

a. POSITIF : Rp.

b. NEGATIF : Rp.

c. JUMLAH (a – b) : …………………………………………………………………

PENGHASILAN NETO FISKAL : (1 +/- 2c) ……………………………………………………

PAJAK PENGHASILAN BADAN TERUTANG : ……………………………………………….

DASAR PENGENAAN PPh PASAL 26 AYAT (4) : (3 - 4) ……………………………………

PPh PASAL 26 AYAT (4) :

a TERUTANG : …… *) % X JUMLAH ANGKA 5 ………………………………………

b TIDAK TERUTANG, KARENA :

c KETENTUAN P3B INDONESIA - …………………………

d DITANAMKAN KEMBALI SELURUHNYA DI INDONESIA

PADA PERSEROAN TERBATAS (PT) BARU : **)

………………………………………………………………………………………

NPWP : e

ALAMAT : f ………………………………………………………………………………………

………………………………………………………………………………………

g KOTA : …………………………………… KODE POS : h

CATATAN : ……………………,

*) TARIF 20% ATAU TARIF P3B

**) LAMPIRAN BUKTI REALISASI PENANAMAN KEMBALI WAJIB PAJAK / KUASA

(……………………………………………………………)

5.

6.

3.

4.

RUPIAH PENUH

1.

2.

LAMPIRAN KHUSUS


2 0PERHITUNGAN PPh PASAL 26 AYAT (4)

6B

FOR TAXABLE YEAR

T I N :

:



a. POSITIVE : US$.

b. NEGATIVE : US$.

c. TOTAL (a – b) : …………………………………………………………………









………………………………………………………………………………………

TIN : e

ADDRESS : f ………………………………………………………………………………………

………………………………………………………………………………………


NOTE: ……………………,



(……………………………………………………………)


6.

4.

5.

3.

US$

1.

2.




6B

TAHUN PAJAK

N P W P :


PENGHASILAN NETO KOMERSIAL : ………………………………………………………

(BERDASARKAN LAPORAN KEUANGAN)

PENYESUAIAN FISKAL :

a. POSITIF : US $

b. NEGATIF : US $

c. JUMLAH (a – b) : …………………………………………………………………

PENGHASILAN NETO FISKAL : (1 +/- 2c) ……………………………………………………

PAJAK PENGHASILAN BADAN TERUTANG : ……………………………………………….

DASAR PENGENAAN PPh PASAL 26 AYAT (4) : (3 - 4) ……………………………………

PPh PASAL 26 AYAT (4) :

a TERUTANG : …… *) % X JUMLAH ANGKA 5 ………………………………………

b TIDAK TERUTANG, KARENA :

c KETENTUAN P3B INDONESIA - …………………………

d DITANAMKAN KEMBALI SELURUHNYA DI INDONESIA

PADA PERSEROAN TERBATAS (PT) BARU : **)

………………………………………………………………………………………

NPWP : e

ALAMAT : f ………………………………………………………………………………………

………………………………………………………………………………………

g KOTA : …………………………………… KODE POS : h

CATATAN : ……………………,

*) TARIF 20% ATAU TARIF P3B

**) LAMPIRAN BUKTI REALISASI PENANAMAN KEMBALI WAJIB PAJAK / KUASA

(……………………………………………………………)

4.

5.

6.

3.

US $

1.

2.

PERHITUNGAN PPh PASAL 26 AYAT (4)

LAMPIRAN KHUSUS



2 0

7A


NOTES : ……………………,







SPECIAL ATTACHMENT

TAXABLE YEAR

2 0

(US$)

NO.

WITHHOLDING AGENT

TYPES OF INCOME

NET AMOUNTTAX DUE / PAID

IN FOREIGN COUNTRY

NAME ADDRESS(US$)

US$ FOREIGN EXCHANGE

(1) (2) (3) (4) (5) (6) (7) (8)

1,

2.

3.

4.

5.

6.

7.

8.

9.

10.

(……………………………………………………………)


FOREIGN TAX CREDIT

TAX CREDITABLE

COLUMN (6) IDR FILL WITH CONVERTION VALUE FROM THE NUMBER IN COLUMN (7) FOREIGN EXCHANGE USING EXCHANGE RATE PREVAILING AT

THE TIME OF TAX PAYMENT/TAX DUE IN FOREIGN COUNTRY

TOTAL TTL

7A


CATATAN : ……………………,

• DIISI DENGAN RINCIAN PER BUKTI PEMOTONGAN / PEMBAYARAN PAJAK.

• KOLOM (6) RUPIAH DIISI DENGAN NILAI KONVERSI DARI ANGKA DALAM KOLOM (7) VALAS DENGAN MENGGUNAKAN KURS PAJAK YANG WAJIB PAJAK / KUASA

BERLAKU PADA TANGGAL PEMBAYARAN / TERUTANGNYA PAJAK DI LUAR NEGERI.

• KREDIT PAJAK YANG DAPAT DIPERHITUNGKAN PADA KOLOM (8) DIHITUNG BERDASARKAN METODE ORDINARY CREDIT PER COUNTRY BASIS .

• PINDAHKAN HASIL PENJUMLAHAN KOLOM (8) KE FORMULIR 1771 HURUF C ANGKA 8.b.

• PINDAHKAN HASIL PENJUMLAHAN KOLOM (5) KE FORMULIR 1771-I Nomor 2.

• JIKA FORMULIR INI TIDAK CUKUP, DAPAT DIGANDAKAN SESUAI KEBUTUHAN.

9.

10.

JML

1,

JUMLAH

3.

4.

5.

6.

7.

8.

(4)(3) (5) (6) (7) (8)

ALAMAT NO.

(1)

PEMOTONG PAJAK

NAMA

(2)

VALASRUPIAH

PAJAK YANG TERUTANG / DIBAYAR

DI LUAR NEGERIJENIS PENGHASILAN

JUMLAH NETO

(RUPIAH)

(……………………………………………………………)

2.


(RUPIAH)

KREDIT PAJAK YANG

DAPAT DIPERHITUNGKAN

KREDIT PAJAK LUAR NEGERI

LAMPIRAN KHUSUS

TAHUN PAJAK

2 0

7B



2.

(7) (8)

1,

(1) (2) (3) (4) (5) (6)

TAX CREDITABLEIN FOREIGN COUNTRYNAME ADDRESS

(US $)US $ FOREIGN EXCHANGE (US $)

FOREIGN TAX CREDIT

NO.WITHHOLDING AGENT

TYPES OF INCOMENET AMOUNT TAX DUE / PAID


TAXABLE YEAR2 0

NOTES : ……………………,

TOTAL TTL

10.

9.

8.

7.

6.

5.

4.

3.








(……………………………………………………………)

7B

TAHUN PAJAK


CATATAN : ……………………,


• KOLOM (6) US $ DIISI DENGAN NILAI KONVERSI DARI ANGKA DALAM KOLOM (7) VALAS DENGAN MENGGUNAKAN KURS PAJAK YANG WAJIB PAJAK / KUASA



• PINDAHKAN HASIL PENJUMLAHAN KOLOM (8) KE FORMULIR 1771/$ HURUF C ANGKA 8.b.

• PINDAHKAN HASIL PENJUMLAHAN KOLOM (5) KE FORMULIR 1771-I/$ NOMOR 2.



LAMPIRAN KHUSUS



2 0


NO.

PEMOTONG PAJAK

JENIS PENGHASILAN

JUMLAH NETOPAJAK YANG TERUTANG / DIBAYAR

(1) (2) (3)

4.

2.

(……………………………………………………………)

10.

9.

KREDIT PAJAK YANGDI LUAR NEGERI

NAMA ALAMAT (US$) DAPAT DIPERHITUNGKAN

US$ VALAS (US$)

(4) (5) (6) (7) (8)

1,

3.

5.

6.

7.

8.

JUMLAH JML

INDUSTRIAL COMPANIES 8A-1

TIN :

TAXPAYER'S NAME :

I. ELEMENTS FROM BALANCE SHEET

NO. NO.

1. CASH AND EQUIVALENT 1. ACCOUNT PAYABLE - THIRD PARTIES

2. TEMPORARY INVESTMENTS 2.

3. ACCOUNT RECEIVABLE - THIRD PARTIES 3. INTEREST PAYABLE

4. 4. TAXES PAYABLE

5. OTHER RECEIVABLE - THIRD PARTIES 5. DIVIDENDS PAYABLE

6. 6. ACCRUED EXPENSES

7. ALLOWANCE FOR DOUBTFUL ACCOUNTS 7. SHORT - TERM BANK LOANS

8. INVENTORIES 8.

9. PREPAID EXPENSES 9. ADVANCES

10. ADVANCES 10. OTHER CURRENT LIABILITIES

11. OTHER CURRENT ASSETS 11. LONG - TERM DEBT - BANK LOANS

12. LONG-TERM RECEIVABLES 12.

13. LAND AND BUILDINGS 13.

14. OTHER FIXED ASSETS 14. DEFFERED TAX LIABILITIES

15. LESS: ACCUMULATED DEPRECIATION 15. OTHER NON-CURRENT LIABILITIES

16. INVESMENT IN ASSOCIATES 16. CAPITAL STOCK

17. OTHER LONG-TERM INVESTMENTS 17.

18. INTANGIBLE ASSETS 18.

19. DEFERRED TAX ASSET 19. RETAINED EARNINGS

20. OTHER NON - CURRENT ASSETS 20. OTHER EQUITY

TOTAL ASSETS

II. ELEMENTS FROM INCOME STATEMENT

NO.

1. NET SALES

2. MATERIALS

3. DIRECT LABOUR

4. FACTORY OVERHEAD

5. MANUFACTURING COST (2 + 3 + 4)

6. WORK IN PROCESS - BEGINNING

7. WORK IN PROCESS - ENDING

8. COST OF GOOD MANUFACTURE (5 + 6 - 7)

9. FINISHED GOODS - BEGINNING

10. FINISHED GOODS - ENDING

11. COST OF GOOD SOLD (8 + 9 - 10)

12. GROSS PROFIT (1 - 11)

13. SELLING EXPENSES

14. GENERAL AND ADMINISTRATIVE EXPENSES

15. PROFIT (12 - 13 - 14)

16. OTHERS INCOME (EXPENSES)

17. NET EARNINGS OF ASSOCIATES

18. INCOME BEFORE INCOME TAX BENEFIT/ (EXPENSE) (15 + 16 + 17)

19. INCOME TAX BENEFIT / (EXPENSE)

20. NET EARNINGS FROM NORMAL ACTIVITIES (18 - 19)

21. EXTRA ORDINARY ITEMS

22. INCOME BEFORE MINORITY INTEREST IN NET EARNINGS OF SUBSIDIARIES (20 + 21)

23. MINORITY INTEREST IN NET EARNINGS OF SUBSIDIARIES

24. NET PROFIT (22 - 23)

III. TRANSACTION WITH RELATED PARTIES UNDER FINANCIAL ACCOUNTING STANDARD GUIDELINES (PSAK) NUMBER 7

NO.

2 0a. ….…………………………………,

(Place)

b. TAXPAYER AUTHORIZED/REPRESENTATIVE

c. FULL NAME OF MANAGEMENT/REPRESENTATIVE

TAXABLE YEAR8A-1 CORPORATE ANNUAL INCOME TAX RETURN

SPECIAL ATTACHMENT

2

DESCRIPTION

0

PARTIES TYPES OF TRANSACTION TRANSACTION VALUE (IDR)

DECLARATION

Understanding All The Sanctions Provided by The Law and Regulations, I Hereby Declare that The Information Stated in this Return, Including All Attachments Provided, are True, Complete, Clear, and Under No Circumstances Whatsoever.

TOTAL LIABILITIES AND OWNERS' EQUITY

VALUE (IDR)

ACCOUNT RECEIVABLE - RELATED PARTIES

OTHER RECEIVABLE - RELATED PARTIES

VALUE (IDR)DESCRIPTION DESCRIPTION

ACCOUNT PAYABLE - RELATED PARTIES

LONG-TERM DEBT-RELATED PARTIES

LONG - TERM DEBTS-CURRENT MATURITIES

VALUE (IDR)

LONG-TERM DEBT-THIRD PARTIES

ADDITONAL PAID - IN CAPITAL

TRANSCRIPT OF ELEMENTS CITATION OF FINANCIAL STATEMENT

(d. Signature and Company Seal)

(year)(date) (month)

RETAINED EARNINGS FROM PREVIOUS YEARS

PERUSAHAAN INDUSTRI 8A-1 MANUFAKTUR TAHUN PAJAK

NPWP :

NAMA WAJIB PAJAK :

I. ELEMEN DARI NERACA

NO. NO.

1. KAS DAN SETARA KAS 1. HUTANG USAHA PIHAK KETIGA

2. INVESTASI SEMENTARA 2.

3. PIUTANG USAHA PIHAK KETIGA 3. HUTANG BUNGA

4. 4. HUTANG PAJAK

5. PIUTANG LAIN-LAIN PIHAK KETIGA 5. HUTANG DIVIDEN

6. 6. BIAYA YANG MASIH HARUS DIBAYAR

7. PENYISIHAN PIUTANG RAGU-RAGU 7. HUTANG BANK

8. PERSEDIAAN 8.

9. BEBAN DIBAYAR DI MUKA 9. UANG MUKA PELANGGAN

10. UANG MUKA PEMBELIAN 10. KEWAJIBAN LANCAR LAINNYA

11. AKTIVA LANCAR LAINNYA 11. HUTANG BANK JANGKA PANJANG

12. PIUTANG JANGKA PANJANG 12.

13. TANAH DAN BANGUNAN 13.

14. AKTIVA TETAP LAINNYA 14. KEWAJIBAN PAJAK TANGGUHAN

15. DIKURANGI: AKUMULASI PENYUSUTAN 15. KEWAJIBAN TIDAK LANCAR LAINNYA

16. INVESTASI PADA PERUSAHAAN ASOSIASI 16. MODAL SAHAM

17. INVESTASI JANGKA PANJANG LAINNYA 17.

18. HARTA TIDAK BERWUJUD 18.

19. AKTIVA PAJAK TANGGUHAN 19. LABA DITAHAN TAHUN INI

20. AKTIVA TIDAK LANCAR LAINNYA 20. EKUITAS LAIN-LAIN

JUMLAH AKTIVA

II. ELEMEN DARI LAPORAN LABA/RUGI

NO.

1. PENJUALAN BERSIH

2. BAHAN BAKU YANG DIGUNAKAN

3. UPAH BURUH LANGSUNG

4. BIAYA PABRIKASI

5. JUMLAH BIAYA PRODUKSI (2 + 3 + 4)

6. SALDO BARANG DALAM PROSES - AWAL

7. SALDO BARANG DALAM PROSES - AKHIR

8. HARGA POKOK PRODUKSI (5 + 6 - 7)

9. SALDO BARANG JADI - AWAL

10. SALDO BARANG JADI - AKHIR

11. HARGA POKOK PENJUALAN (8 + 9 - 10)

12. LABA KOTOR (1 - 11)

13. BEBAN PENJUALAN

14. BEBAN UMUM DAN ADMINISTRASI

15. LABA USAHA (12 - 13 - 14)

16. PENGHASILAN/(BEBAN) LAIN

17. BAGIAN LABA (RUGI) PERUSAHAAN ASOSIASI

18. LABA/RUGI SEBELUM PAJAK PENGHASILAN (15 + 16 + 17)

19. BEBAN (MANFAAT) PAJAK PENGHASILAN

20. LABA (RUGI) DARI AKTIVITAS NORMAL (18 - 19)

21. POS LUAR BIASA

22. LABA/RUGI SEBELUM HAK MINORITAS (20 + 21)

23. HAK MINORITAS ATAS LABA (RUGI) BERSIH ANAK PERUSAHAAN

24. LABA BERSIH (22 - 23)

III. ELEMEN TRANSAKSI DENGAN PIHAK-PIHAK YANG MEMPUNYAI HUBUNGAN ISTIMEWA SESUAI DENGAN PSAK NOMOR 7

NO.

a. ….…………………………………, 2 0(Tempat)

b. WAJIB PAJAK KUASA

c. NAMA LENGKAP PENGURUS/KUASA

(d. Tanda Tangan dan Cap Perusahaan)

(thn)(tgl) (bln)

LABA DITAHAN TAHUN-TAHUN SEBELUMNYA

NILAI (RUPIAH)URAIAN

HUTANG USAHA JANGKA PANJANG PIHAK LAIN

AGIO SAHAM (TAMBAHAN MODAL DISETOR)

HUTANG USAHA JANGKA PANJANG PIHAK YANG MEMPUNYAI HUBUNGAN ISTIMEWA

BAGIAN HUTANG JANGKA PANJANG YANG JATUH TEMPO DALAM TAHUN BERJALAN

PIUTANG USAHA PIHAK YANG MEMPUNYAI HUBUNGAN ISTIMEWA

PIUTANG LAIN-LAIN PIHAK YANG MEMPUNYAI HUBUNGAN ISTIMEWA

NILAI (RUPIAH)URAIAN URAIAN

HUTANG USAHA PIHAK YANG MEMPUNYAI HUBUNGAN ISTIMEWA

NILAI (RUPIAH)

JUMLAH KEWAJIBAN DAN EKUITAS

JENIS TRANSAKSI NILAI TRANSAKSI (RUPIAH)

Dengan menyadari sepenuhnya akan segala akibatnya termasuk sanksi-sanksi sesuai dengan ketentuan perundang-undangan yang berlaku, saya menyatakan bahwa apa yang telah saya beritahukan di atas adalah benar, lengkap dan jelas.

PERNYATAAN

PIHAK-PIHAK

8A-1 SPT TAHUNAN PAJAK PENGHASILAN WAJIB PAJAK BADAN

TRANSKRIP KUTIPAN ELEMEN-ELEMEN 2 0

LAMPIRAN KHUSUS

DARI LAPORAN KEUANGAN

INDUSTRIAL COMPANIES 8B-1

TIN :

TAXPAYER'S NAME :


NO. NO.

1. CASH AND EQUIVALENT 1. ACCOUNT PAYABLE - THIRD PARTIES



4. 4. TAXES PAYABLE

5. OTHER RECEIVABLE - THIRD PARTIES 5. DIVIDENDS PAYABLE



8. INVENTORIES 8.



11. OTHER CURRENT ASSETS 11. LONG - TERM DEBT - BANK LOANS

12. LONG-TERM RECEIVABLES 12.



15. LESS: ACCUMULATED DEPRECIATION 15. OTHER NON-CURRENT LIABILITIES

16. INVESMENT IN ASSOCIATES 16. CAPITAL STOCK

17. OTHER LONG-TERM INVESTMENTS 17.



20. OTHER NON - CURRENT ASSETS 20. OTHER EQUITY

TOTAL ASSETS


NO.

1. NET SALES

2. MATERIALS

3. DIRECT LABOUR

4. FACTORY OVERHEAD

5. MANUFACTURING COST (2 + 3 + 4)

6. WORK IN PROCESS - BEGINNING

7. WORK IN PROCESS - ENDING

8. COST OF GOOD MANUFACTURE (5 + 6 - 7)

9. FINISHED GOODS - BEGINNING

10. FINISHED GOODS - ENDING





15. PROFIT (12 - 13 - 14)

16. OTHERS INCOME (EXPENSES)


18. INCOME BEFORE INCOME TAX BENEFIT/ (EXPENSE) (15 + 16 + 17)




22. INCOME BEFORE MINORITY INTEREST IN NET EARNINGS OF SUBSIDIARIES (20 + 21)

23. MINORITY INTEREST IN NET EARNINGS OF SUBSIDIARIES

24. NET PROFIT (22 - 23)


NO.

2 0a. ….…………………………………,

(Place)



FOR CORPORATION PERMITTED TO MAINTAIN BOOKS OF ACCOUNT IN ENGLISH LANGUAGE AND UNITED STATES DOLLAR CURRENCY



(year)(date) (month)


VALUE (US$)

LONG-TERM DEBT-THIRD PARTIES

ADDITONAL PAID - IN CAPITAL

LONG-TERM DEBT-RELATED PARTIES




VALUE (US$)DESCRIPTION DESCRIPTION


VALUE (US$)



DECLARATION

TYPES OF TRANSACTION TRANSACTION VALUE (US$)PARTIES

TAXABLE YEAR8B-1 CORPORATE ANNUAL INCOME TAX RETURN

SPECIAL ATTACHMENT

2

DESCRIPTION

0

PERUSAHAAN INDUSTRI 8B-1

MANUFAKTUR TAHUN PAJAK

NPWP :

NAMA WAJIB PAJAK :


NO. NO.




4. 4. HUTANG PAJAK




8. PERSEDIAAN 8.













JUMLAH AKTIVA


NO.

1. PENJUALAN BERSIH

2. BAHAN BAKU YANG DIGUNAKAN

3. UPAH BURUH LANGSUNG

4. BIAYA PABRIKASI

5. JUMLAH BIAYA PRODUKSI (2 + 3 + 4)

6. SALDO BARANG DALAM PROSES - AWAL

7. SALDO BARANG DALAM PROSES - AKHIR

8. HARGA POKOK PRODUKSI (5 + 6 - 7)

9. SALDO BARANG JADI - AWAL

10. SALDO BARANG JADI - AKHIR


12. LABA KOTOR (1 - 11)

13. BEBAN PENJUALAN


15. LABA USAHA (12 - 13 - 14)






21. POS LUAR BIASA





NO.

a. ….…………………………………, 2 0(Tempat)




(thn)(tgl) (bln)


URAIAN


HUTANG USAHA JANGKA PANJANG PIHAK YANG

MEMPUNYAI HUBUNGAN ISTIMEWA

NILAI (US$)

PIUTANG USAHA PIHAK YANG MEMPUNYAI HUBUNGAN

ISTIMEWA

PIUTANG LAIN-LAIN PIHAK YANG MEMPUNYAI HUBUNGAN

ISTIMEWA

BAGIAN HUTANG JANGKA PANJANG YANG JATUH

TEMPO DALAM TAHUN BERJALAN


NILAI (US$)URAIAN URAIAN

HUTANG USAHA PIHAK YANG MEMPUNYAI

HUBUNGAN ISTIMEWA

NILAI (US$)


JENIS TRANSAKSI NILAI TRANSAKSI (US$)

Dengan menyadari sepenuhnya akan segala akibatnya termasuk sanksi-sanksi sesuai dengan ketentuan perundang-undangan yang berlaku, saya menyatakan bahwa apa yang telah

saya beritahukan di atas adalah benar, lengkap dan jelas.

PERNYATAAN

PIHAK-PIHAK

SPT TAHUNAN PAJAK PENGHASILAN WAJIB PAJAK BADAN8B-1

LAMPIRAN KHUSUS

02TRANSKRIP KUTIPAN ELEMEN-ELEMEN




8A-2TRADING COMPANIES

TIN :

TAXPAYER'S NAME :

I. ELEMENT FROM BALANCE SHEET

NO. NO.

1. CASH AND EQUIVALENT 1. ACCOUNT PAYABLE -THIRD PARTIES



4. 4. TAXES PAYABLE

5. OTHER RECEIVABLE - THIRD PARTIES 5. DIVIDEND PAYABLE



8. INVENTORIES 8.



11. OTHER CURRENT ASSET 11. LONG - TERM DEBT - BANK LOANS

12. LONG - TERM RECEIVABLES 12.



15. LESS: ACCUMULATED DEPRECIATION 15. OTHER LONG - TERM LIABILITIES

16. INVESTMENTS IN ASOCIATES 16. CAPITAL STOCK

17. OTHER LONG - TERM INVESTMENTS 17.



20. OTHER NON - CURRENT ASSET 20. OTHER EQUITY

TOTAL ASSETS


NO.

1. NET SALES

2. PURCHASE

3. MERCHANDISE INVENTORY- BEGINNING

4. MERCHANDISE INVENTORY- ENDING



7. SALES EXPENSE


9. PROFIT (6 - 7 - 8)

10. INCOME/(EXPENSE) OTHER


12. INCOME BEFORE INCOME TAX (9 + 10 + 11)

13. INCOME TAX BENEFIT (EXPENSE)


15. EXTRAORDINARY ITEMS

16. GAIN/LOSS BEFORE MINORITY INTEREST (14 + 15)

17. MINORITY INTEREST IN NET EARNIGS OF SUBSIDIARIES

18. NET PROFIT (16 - 17)


NO.

a. ….…………………………………, 2 0(Place)



2 0



LONG - TERM DEBT - THIRD PARTIES

LONG -TERM DEBT - RELATED PARTIES



ADDITIONAL PAID-IN CAPITAL

DESCRIPTION VALUE (IDR)



SPECIAL ATTACHMENT

DESCRIPTION VALUE (IDR) DESCRIPTION VALUE (IDR)

8A-2 CORPORATE ANNUAL INCOME TAX RETURN


TAXABLE YEAR

TYPES OF TRANSACTION TRANSACTION VALUE (IDR)

DECLARATION


(date) (month) (year)

PARTIES


PERUSAHAAN 8A-2 DAGANG TAHUN PAJAK

NPWP :

NAMA WAJIB PAJAK :


NO. NO.




4. 4. HUTANG PAJAK




8. PERSEDIAAN 8.













JUMLAH AKTIVA


NO.

1. PENJUALAN BERSIH

2. PEMBELIAN

3. SALDO BARANG DAGANGAN - AWAL

4. SALDO BARANG DAGANGAN - AKHIR


6. LABA KOTOR (1 - 5)

7. BEBAN PENJUALAN


9. LABA USAHA (6 - 7 - 8)






15. POS LUAR BIASA





NO.

a. ….…………………………………, 2 0(Tempat)



JENIS TRANSAKSI NILAI TRANSAKSI (RUPIAH)

PERNYATAAN


Dengan menyadari sepenuhnya akan segala akibatnya termasuk sanksi-sanksi sesuai dengan ketentuan perundang-undangan yang berlaku, saya menyatakan bahwa apa yang telah saya beritahukan di atas adalah benar, lengkap dan jelas.

(tgl) (bln) (thn)

PIHAK-PIHAK

LAMPIRAN KHUSUS

URAIAN NILAI (RUPIAH) URAIAN NILAI (RUPIAH)


8A-2 SPT TAHUNAN PAJAK PENGHASILAN WAJIB PAJAK BADAN

TRANSKRIP KUTIPAN ELEMEN-ELEMEN 2

HUTANG USAHA PIHAK YANG MEMPUNYAI HUBUNGAN ISTIMEWA

PIUTANG USAHA PIHAK YANG MEMPUNYAI HUBUNGAN ISTIMEWA

PIUTANG LAIN-LAIN PIHAK YANG MEMPUNYAI HUBUNGAN ISTIMEWA

BAGIAN HUTANG JANGKA PANJANG YANG JATUH TEMPO DALAM TAHUN BERJALAN


HUTANG USAHA JANGKA PANJANG PIHAK YANG MEMPUNYAI HUBUNGAN ISTIMEWA



URAIAN NILAI (RUPIAH)


0

8B-2TRADING COMPANIES

TIN :

TAXPAYER'S NAME :


NO. NO.

1. CASH AND EQUIVALENT 1. ACCOUNT PAYABLE -THIRD PARTIES



4. 4. TAXES PAYABLE

5. OTHER RECEIVABLE - THIRD PARTIES 5. DIVIDEND PAYABLE



8. INVENTORIES 8.



11. OTHER CURRENT ASSET 11. LONG - TERM DEBT - BANK LOANS

12. LONG - TERM RECEIVABLES 12.



15. LESS: ACCUMULATED DEPRECIATION 15. OTHER LONG - TERM LIABILITIES

16. INVESTMENTS IN ASOCIATES 16. CAPITAL STOCK




20. OTHER NON - CURRENT ASSET 20. OTHER EQUITY

TOTAL ASSETS


NO.

1. NET SALES

2. PURCHASE

3. MERCHANDISE INVENTORY- BEGINNING

4. MERCHANDISE INVENTORY- ENDING



7. SALES EXPENSE


9. PROFIT (6 - 7 - 8)

10. INCOME/(EXPENSE) OTHER








18. NET PROFIT (16 - 17)


NO.

a. ….…………………………………, 2 0(Place)



TYPES OF TRANSACTION TRANSACTION VALUE (US$)

DECLARATION



PARTIES


SPECIAL ATTACHMENT

DESCRIPTION VALUE (US$) DESCRIPTION VALUE (US$)

8B-2 CORPORATE ANNUAL INCOME TAX RETURN

FOR CORPORATION PERMITTED TO MAINTAIN BOOKKEEPING IN ENGLISH LANGUAGE AND UNITED STATE DOLLAR CURRENCY


TAXABLE YEAR



DESCRIPTION VALUE (US$)





LONG - TERM DEBT - THIRD PARTIES

LONG -TERM DEBT - RELATED PARTIES


2 0

PERUSAHAAN 8B-2

DAGANG TAHUN PAJAK

NPWP :

NAMA WAJIB PAJAK :


NO. NO.




4. 4. HUTANG PAJAK




8. PERSEDIAAN 8.













JUMLAH AKTIVA


NO.

1. PENJUALAN BERSIH

2. PEMBELIAN

3. SALDO BARANG DAGANGAN - AWAL

4. SALDO BARANG DAGANGAN - AKHIR



7. BEBAN PENJUALAN


9. LABA USAHA (6 - 7 - 8)






15. POS LUAR BIASA





NO.

a. ….…………………………………, 2 0(Tempat)



JENIS TRANSAKSI NILAI TRANSAKSI (US$)

PERNYATAAN




(tgl) (bln) (thn)

PIHAK-PIHAK

URAIAN NILAI (US$) URAIAN NILAI (US$)




TRANSKRIP KUTIPAN ELEMEN-ELEMEN



HUBUNGAN ISTIMEWA


ISTIMEWA


ISTIMEWA









URAIAN NILAI (US$)

8B-2

2 0

LAMPIRAN KHUSUS

8A-3 CONVENTIONAL BANKS

TAXABLE YEAR

TIN :

TAXPAYER'S NAME :


NO. NO.

1. CASH 1. OBLIGATION DUE IMMEDIATELY

2. GIRO AT CENTRAL BANK 2.

3. GIRO AT OTHER BANK - NET 3.

4. 4. DEPOSITS FROM OTHER BANKS

5. 5.

6. 6. DERIVATIVE PAYABLES

7. 7. ACCEPTANCE PAYABLES

8. 8. TAXES PAYABLE

9. DERIVATIVE RECEIVABLES, NET OF ALLOWANCE 9. MARKETABLE SECURITIES ISSUED

10. LOANS, NET OF ALLOWANCE 10. LOAN RECEIVED

11. 11.

12. ACCEPTANCE RECEIVABLES, NET OF ALLOWANCE 12. DEFFERED TAX LIABILITIES

13. GOVERNMENT BONDS 13. ACCRUALS LIABILITIES

14. INVESTMENTS, NET OF ALLOWANCE 14. OTHER LIABILITIES

15. GOODWILL - NET OF ACCUMULATED AMORTIZATION 15. SUBORDINATED DEBTS

16. FIXED ASSET 16. CAPITAL STOCK

17. LESS: ACCUMULATED DEPRECIATION 17.

18. DEFFERED TAX ASSET 18.

19. PREPAID EXPENSES 19. RETAINED EARNINGS

20. OTHER ASSETS 20. OTHER EQUITY

TOTAL ASSETS


NO.

1. INTEREST INCOME

2. INTEREST EXPENSE

3. NET INTEREST INCOME (1 - 2)

4. OTHER OPERATING INCOME

5. OTHER OPERATING EXPENSES

6. INCOME FROM OPERATIONS (3 + 4 - 5)

7. NON-OPERATING INCOME

8. NON-OPERATING EXPENSES

9. NON-OPERATING INCOME - NET (7 - 8)


11. INCOME BEFORE INCOME TAX (3 + 6 + 9 + 10)


13. NET EARNINGS FROM NORMAL ACTIVITIES ( 11 - 12)


15. INCOME BEFORE MINORITY INTEREST IN NET EARNIGS OF SUBSIDIARIES (13-14)


17. NET PROFIT (15 - 16)


NO.

2 0a. ….…………………………………,

(Place)



2 0


8A-3 CORPORATE ANNUAL INCOME TAX RETURNSPECIAL ATTACHMENT


DEPOSITS FROM CUSTOMERS - THIRD PARTIES

DEPOSITS FROM CUSTOMERS - RELATED PARTIES

MARKETABLE SECURITIES SOLD UNDER REPURCHASE AGREEMENTS, NET OF ALLOWANCE

ESTIMATED LOSSES ON COMMITMENTS AND CONTIGENCIES



PLACEMENTS ON CENTRAL BANK - NET

PLACEMENTS ON OTHER BANKS - NET

MARKETABLE SECURITIES - RELATED PARTIES

MARKETABLE SECURITIES - THIRD PARTIES

MARKETABLE SECURITIES PURCHASED UNDER RESALE AGREEMENT, NET OF ALLOWANCE

CONSUMER FINANCING RECEIVABLES, NET OF ALLOWANCE

ADDITIONAL PAID - IN CAPITAL



DECLARATION




BANK 8A-3

KONVENSIONAL TAHUN PAJAK

NPWP :

NAMA WAJIB PAJAK :


NO. NO.

1. KAS 1. KEWAJIBAN SEGERA

2. GIRO PADA BANK INDONESIA 2.

3. GIRO PADA BANK LAIN - BERSIH 3. SIMPANAN NASABAH PIHAK KETIGA

4. 4. SIMPANAN DARI BANK LAIN

5. 5.

6. 6. KEWAJIBAN DERIVATIF

7. SURAT BERHARGA PIHAK KETIGA - BERSIH 7. KEWAJIBAN AKSEPTASI

8. 8. HUTANG PAJAK

9. TAGIHAN DERIVATIF - BERSIH 9. SURAT BERHARGA YANG DITERBITKAN

10. PINJAMAN YANG DIBERIKAN - BERSIH 10. PINJAMAN YANG DITERIMA

11. 11.

12. TAGIHAN AKSEPTASI - BERSIH 12. KEWAJIBAN PAJAK TANGGUHAN

13. OBLIGASI PEMERINTAH 13. BEBAN YANG MASIH HARUS DIBAYAR

14. PENYERTAAN SAHAM - BERSIH 14. KEWAJIBAN LAIN-LAIN

15. GOODWIL - BERSIH 15. PINJAMAN SUBORDINASI

16. AKTIVA TETAP 16. MODAL SAHAM

17. DIKURANGI: AKUMULASI PENYUSUTAN 17.

18. AKTIVA PAJAK TANGGUHAN 18.

19. BIAYA DIBAYAR DI MUKA 19. LABA DITAHAN TAHUN INI

20. AKTIVA LAIN-LAIN BERSIH 20. EKUITAS LAIN-LAIN

JUMLAH AKTIVA


NO.

1. PENDAPATAN BUNGA

2. BEBAN BUNGA

3. PENDAPATAN BUNGA - BERSIH (1 - 2)

4. PENDAPATAN OPERASI LAINNYA

5. BEBAN OPERASIONAL LAINNYA

6. PENDAPATAN/(BEBAN) OPERASIONAL LAINNYA - BERSIH (4 - 5)

7. PENDAPATAN BUKAN OPERASIONAL

8. BEBAN BUKAN OPERASIONAL

9. PENDAPATAN NON OPERASIONAL - BERSIH (7 - 8)


11. LABA/RUGI SEBELUM PAJAK PENGHASILAN (3 + 6 + 9 + 10)



14. POS LUAR BIASA





NO.

a. ….…………………………………, 2 0(Tempat)



SIMPANAN NASABAH PIHAK YANG MEMPUNYAI

HUBUNGAN ISTIMEWA

PENEMPATAN PADA BANK INDONESIA - BERSIH

SURAT BERHARGA PIHAK YANG MEMPUNYAI HUBUNGAN

ISTIMEWA - BERSIH

(bln) (thn)






PIHAK-PIHAK JENIS TRANSAKSI NILAI TRANSAKSI (RUPIAH)

PERNYATAAN

PENEMPATAN PADA BANK LAIN - BERSIH



(tgl)

PIUTANG PEMBIAYAAN KONSUMEN - BERSIH

SURAT BERHARGA YANG DIJUAL DENGAN JANJI

DIBELI KEMBALI - BERSIH


SURAT BERHARGA YANG DIBELI DENGAN JANJI DIJUAL

KEMBALI - BERSIH

ESTIMASI KERUGIAN KOMITMEN DAN KONTIJENSI

8A-3SPT TAHUNAN PAJAK PENGHASILAN WAJIB PAJAK BADAN



LAMPIRAN KHUSUS

8B-3 CONVENTIONAL BANKS

TAXABLE YEAR

TIN :

TAXPAYER'S NAME :


NO. NO.

1. CASH 1. OBLIGATION DUE IMMEDIATELY

2. GIRO AT CENTRAL BANK 2.

3. GIRO AT OTHER BANK - NET 3.

4. 4. DEPOSITS FROM OTHER BANKS

5. 5.

6. 6. DERIVATIVE PAYABLES

7. 7. ACCEPTANCE PAYABLES

8. 8. TAXES PAYABLE

9. DERIVATIVE RECEIVABLES, NET OF ALLOWANCE 9. MARKETABLE SECURITIES ISSUED

10. LOANS, NET OF ALLOWANCE 10. LOAN RECEIVED

11. 11.

12. ACCEPTANCE RECEIVABLES, NET OF ALLOWANCE 12. DEFFERED TAX LIABILITIES

13. GOVERNMENT BONDS 13. ACCRUALS LIABILITIES

14. INVESTMENTS, NET OF ALLOWANCE 14. OTHER LIABILITIES

15. GOODWILL - NET OF ACCUMULATED AMORTIZATION 15. SUBORDINATED DEBTS



18. DEFFERED TAX ASSET 18.

19. PREPAID EXPENSES 19. RETAINED EARNINGS


TOTAL ASSETS


NO.

1. INTEREST INCOME

2. INTEREST EXPENSE

3. NET INTEREST INCOME (1 - 2)

4. OTHER OPERATING INCOME



7. NON-OPERATING INCOME

8. NON-OPERATING EXPENSES

9. NON-OPERATING INCOME - NET (7 - 8)


11. INCOME BEFORE INCOME TAX (3 + 6 + 9 + 10)


13. NET EARNINGS FROM NORMAL ACTIVITIES ( 11 - 12)




17. NET PROFIT (15 - 16)


NO.

2 0a. ….…………………………………,

(Place)






PARTIES TYPES OF TRANSACTION TRANSACTION VALUE (US$)

DECLARATION


ADDITIONAL PAID - IN CAPITAL

MARKETABLE SECURITIES - THIRD PARTIES

MARKETABLE SECURITIES PURCHASED UNDER RESALE AGREEMENT, NET OF ALLOWANCE

CONSUMER FINANCING RECEIVABLES, NET OF ALLOWANCE


PLACEMENTS ON CENTRAL BANK - NET

PLACEMENTS ON OTHER BANKS - NET

MARKETABLE SECURITIES - RELATED PARTIES

MARKETABLE SECURITIES SOLD UNDER REPURCHASE AGREEMENTS, NET OF ALLOWANCE

ESTIMATED LOSSES ON COMMITMENTS AND CONTIGENCIES


8B-3 CORPORATE ANNUAL INCOME TAX RETURNSPECIAL ATTACHMENT


DEPOSITS FROM CUSTOMERS - THIRD PARTIES

DEPOSITS FROM CUSTOMERS - RELATED PARTIES

2 0FOR CORPORATION PERMITTED TO MAINTAIN BOOKKEEPING IN ENGLISH LANGUAGE AND UNITED STATE DOLLAR CURRENCY


BANK 8B-3

KONVENSIONAL TAHUN PAJAK

NPWP :

NAMA WAJIB PAJAK :


NO. NO.

1. KAS 1. KEWAJIBAN SEGERA

2. GIRO PADA BANK INDONESIA 2.

3. GIRO PADA BANK LAIN - BERSIH 3. SIMPANAN NASABAH PIHAK KETIGA

4. 4. SIMPANAN DARI BANK LAIN

5. 5.

6. 6. KEWAJIBAN DERIVATIF

7. SURAT BERHARGA PIHAK KETIGA - BERSIH 7. KEWAJIBAN AKSEPTASI

8. 8. HUTANG PAJAK

9. TAGIHAN DERIVATIF - BERSIH 9. SURAT BERHARGA YANG DITERBITKAN

10. PINJAMAN YANG DIBERIKAN - BERSIH 10. PINJAMAN YANG DITERIMA

11. 11.

12. TAGIHAN AKSEPTASI - BERSIH 12. KEWAJIBAN PAJAK TANGGUHAN

13. OBLIGASI PEMERINTAH 13. BEBAN YANG MASIH HARUS DIBAYAR

14. PENYERTAAN SAHAM - BERSIH 14. KEWAJIBAN LAIN-LAIN

15. GOODWIL - BERSIH 15. PINJAMAN SUBORDINASI




19. BIAYA DIBAYAR DI MUKA 19. LABA DITAHAN TAHUN INI

20. AKTIVA LAIN-LAIN BERSIH 20. EKUITAS LAIN-LAIN

JUMLAH AKTIVA


NO.

1. PENDAPATAN BUNGA

2. BEBAN BUNGA

3. PENDAPATAN BUNGA - BERSIH (1 - 2)

4. PENDAPATAN OPERASI LAINNYA


6. PENDAPATAN/(BEBAN) OPERASIONAL LAINNYA - BERSIH (4 - 5)



9. PENDAPATAN NON OPERASIONAL - BERSIH (7 - 8)


11. LABA/RUGI SEBELUM PAJAK PENGHASILAN (3 + 6 + 9 + 10)



14. POS LUAR BIASA





NO.

a. ….…………………………………, 2 0(Tempat)



02

SIMPANAN NASABAH PIHAK YANG MEMPUNYAI

HUBUNGAN ISTIMEWA

PENEMPATAN PADA BANK INDONESIA - BERSIH

SURAT BERHARGA PIHAK YANG MEMPUNYAI HUBUNGAN

ISTIMEWA - BERSIH



(tgl) (bln) (thn)




URAIAN NILAI (US$)


PIHAK-PIHAK JENIS TRANSAKSI NILAI TRANSAKSI (US$)

PERNYATAAN



LAMPIRAN KHUSUS



8B-3SPT TAHUNAN PAJAK PENGHASILAN WAJIB PAJAK BADAN



SURAT BERHARGA YANG DIBELI DENGAN JANJI DIJUAL

KEMBALI - BERSIH

ESTIMASI KERUGIAN KOMITMEN DAN KONTIJENSIPIUTANG PEMBIAYAAN KONSUMEN - BERSIH

SURAT BERHARGA YANG DIJUAL DENGAN JANJI

DIBELI KEMBALI - BERSIH

SHARIA 8A-4BANKS

TIN :

TAXPAYER'S NAME :


NO. NO.

1. CASH AND EQUIVALENT 1. OBLIGATION DUE IMMEDIATELY

2. PLACEMENTS ON CENTRAL BANK 2.

3. GIRO ON OTHER BANKS - NET 3.

4. 4. LIABILITIY TO OTHER BANK

5. 5.

6. 6.

7. 7. ZAKAT PAYABLE

8. 8. TAX PAYABLE

9. INVENTORIES (ASSET FOR RESALES) 9. DEFERRED TAX LIABILITIES

10. ASSETS ACQUIRED FOR IJARAH 10. OTHER PAYABLE

11. ASSET OF ISTISHNA IN COMPLETION 11.

12. INVESTMENT 12.



15. DEFERRED TAX ASSETS 15.

16. PREPAID EXPENSES 16. RETAINED EARNING FOR THIS YEAR


TOTAL ASSETS


NO.

1. OPERATING REVENUE

2. RIGHT OF THIRD PARTIES ON THE UNRELATED INVESTMENT RETURN

3. MAJOR OPERATIONS INCOME - NET (1 - 2)

4. OTHER OPERATING REVENUES



7. NON-OPERATING REVENUE

8. NON OPERATING EXPENSES


10. INCOME BEFORE INCOME TAX (6 + 7 - 8 + 9)






16. NET PROFIT (14 - 15)


NO.

2 0

a. ….…………………………………,(Place)



TAXABLE YEAR


TOTAL LIABILITIES AND OWNER'S EQUITY

MUSYAROKAH FINANCING

VALUE (IDR)DESCRIPTION


PREVIOUS RETAINED EARNING

(MUDHARABAH DEPOSIT AND SAVING) BANK


DECLARATION

(date)

(MUDAROBAH DEPOSIT AND SAVING) NON BANK

(month) (year)


UNDISTRIBUTED OF PROFIT ANNOUNCED


DESCRIPTION

DEPOSIT (WADIAH SAVING AND GIRO)

OTHER LIABILITY (SALAM LIABILITY AND ISTISHNA LIABILITY)

SECURITIES RECEIVED FINANCING

SPECIAL ATTACHMENT8A-4

VALUE (IDR)DESCRIPTION

RECEIVABLES (MURABAHAH, SALAM, ISTISHNA, IJAROH, ETC)

VALUE (IDR)

TRANSCRIPT OF ELEMENTS CITATION OF FINANCIAL STATEMENT 2 0

MUDHARABAH FINANCING

PLACEMENT ON OTHER BANK - NET

BANK 8A-4

SYARIAH TAHUN PAJAK

NPWP :

NAMA WAJIB PAJAK :


NO. NO.

1. KAS DAN SETARA KAS 1. KEWAJIBAN SEGERA

2. PENEMPATAN PADA BANK INDONESIA 2.

3. GIRO PADA BANK LAIN - BERSIH 3.

4. 4. KEWAJIBAN PADA BANK LAIN

5. 5.

6. 6.

7. 7. HUTANG ZAKAT

8. 8. HUTANG PAJAK

9. PERSEDIAAN (AKTIVA UNTUK DIJUAL KEMBALI) 9. KEWAJIBAN PAJAK TANGGUHAN

10. AKTIVA YANG DIPEROLEH UNTUK IJAROH 10. HUTANG LAINNYA

11. AKTIVA ISTISHNA DALAM PENYELESAIAN 11.

12. PENYERTAAN 12.




16. BIAYA DIBAYAR DIMUKA 16. LABA DITAHAN TAHUN INI

17. AKTIVA LAIN-LAIN 17. EKUITAS LAIN-LAIN

JUMLAH AKTIVA


NO.

1. PENDAPATAN OPERASI UTAMA

2. HAK PIHAK KETIGA ATAS BAGI HASIL INVESTASI TIDAK TERIKAT

3. PENDAPATAN OPERASI UTAMA - BERSIH (1 - 2)

4. PENDAPATAN OPERASIONAL LAINNYA


6. LABA OPERASIONAL (3 + 4 - 5)




10. LABA SEBELUM PAJAK PENGHASILAN (6 + 7 - 8 + 9)



13. POS LUAR BIASA

14. LABA/RUGI SEBELUM HAK MINORITAS (12 - 13)




NO.

a. ….…………………………………, 2 0(Tempat)




LAMPIRAN KHUSUS8A-4

SIMPANAN (GIRO DAN TABUNGAN WADIAH)

KEWAJIBAN LAIN (HUTANG SALAM DAN HUTANG

ISTISHNA)

INVESTASI TIDAK TERIKAT BUKAN BANK (TABUNGAN

DAN DEPOSITO MUDHARABAH)


PERNYATAAN



(tgl) (bln) (thn)


NILAI (RUPIAH)URAIAN URAIAN NILAI (RUPIAH)

EFEK - EFEK



JUMLAH KEWAJIBAN, ITT DAN EKUITAS

NILAI (RUPIAH)URAIAN

PIUTANG (MURABAHAH, SALAM, ISTISHNA, IJAROH DLL)

PEMBIAYAAN MUDHARABAH

PEMBIAYAAN MUSYAROKAH

PEMBIAYAAN YANG DITERIMA

KEUNTUNGAN YANG SUDAH DIUMUMKAN BELUM

DIBAGI

INVESTASI TIDAK TERIKAT BANK (TABUNGAN DAN

DEPOSITO MUDHARABAH)




SHARIA 8B-4BANKS

TIN :

TAXPAYER'S NAME :


NO. NO.

1. CASH AND EQUIVALENT 1. OBLIGATION DUE IMMEDIATELY

2. PLACEMENTS ON CENTRAL BANK 2.

3. GIRO ON OTHER BANKS - NET 3.

4. 4. LIABILITIY TO OTHER BANK

5. 5.

6. 6.

7. 7. ZAKAT PAYABLE

8. 8. TAX PAYABLE

9. INVENTORIES (ASSET FOR RESALES) 9. DEFERRED TAX LIABILITIES

10. ASSETS ACQUIRED FOR IJARAH 10. OTHER PAYABLE

11. ASSET OF ISTISHNA IN COMPLETION 11.

12. INVESTMENT 12.



15. DEFERRED TAX ASSETS 15.

16. PREPAID EXPENSES 16. RETAINED EARNING FOR THIS YEAR


TOTAL ASSETS


NO.

1. OPERATING REVENUE

2. RIGHT OF THIRD PARTIES ON THE UNRELATED INVESTMENT RETURN

3. MAJOR OPERATIONS INCOME - NET (1 - 2)

4. OTHER OPERATING REVENUES



7. NON-OPERATING REVENUE

8. NON OPERATING EXPENSES


10. INCOME BEFORE INCOME TAX (6 + 7 - 8 + 9)






16. NET PROFIT (14 - 15)


NO.

2 0

a. ….…………………………………,(Place)



RECEIVABLES (MURABAHAH, SALAM, ISTISHNA, IJAROH, ETC)

VALUE (US$)

TRANSCRIPT OF ELEMENTS CITATION OF FINANCIAL STATEMENT 2 0

MUDHARABAH FINANCING

PLACEMENT ON OTHER BANK - NET

SECURITIES RECEIVED FINANCING

SPECIAL ATTACHMENT8B-4

VALUE (US$)DESCRIPTION DESCRIPTION

DEPOSIT (WADIAH SAVING AND GIRO)

OTHER LIABILITY (SALAM LIABILITY AND ISTISHNA LIABILITY)


UNDISTRIBUTED OF PROFIT ANNOUNCED


(MUDAROBAH DEPOSIT AND SAVING) NON BANK

(month) (year)


DECLARATION

(date)


PREVIOUS RETAINED EARNING

(MUDHARABAH DEPOSIT AND SAVING) BANK

MUSYAROKAH FINANCING

VALUE (US$)DESCRIPTION

TAXABLE YEAR



TOTAL LIABILITIES AND OWNER'S EQUITY

BANK 8B-4

SYARIAH TAHUN PAJAK

NPWP :

NAMA WAJIB PAJAK :


NO. NO.

1. KAS DAN SETARA KAS 1. KEWAJIBAN SEGERA

2. PENEMPATAN PADA BANK INDONESIA 2.

3. GIRO PADA BANK LAIN - BERSIH 3.

4. 4. KEWAJIBAN PADA BANK LAIN

5. 5.

6. 6.

7. 7. HUTANG ZAKAT

8. 8. HUTANG PAJAK

9. PERSEDIAAN (AKTIVA UNTUK DIJUAL KEMBALI) 9. KEWAJIBAN PAJAK TANGGUHAN

10. AKTIVA YANG DIPEROLEH UNTUK IJAROH 10. HUTANG LAINNYA

11. AKTIVA ISTISHNA DALAM PENYELESAIAN 11.

12. PENYERTAAN 12.




16. BIAYA DIBAYAR DIMUKA 16. LABA DITAHAN TAHUN INI


JUMLAH AKTIVA


NO.

1. PENDAPATAN OPERASI UTAMA

2. HAK PIHAK KETIGA ATAS BAGI HASIL INVESTASI TIDAK TERIKAT

3. PENDAPATAN OPERASI UTAMA - BERSIH (1 - 2)

4. PENDAPATAN OPERASIONAL LAINNYA


6. LABA OPERASIONAL (3 + 4 - 5)




10. LABA SEBELUM PAJAK PENGHASILAN (6 + 7 - 8 + 9)



13. POS LUAR BIASA

14. LABA/RUGI SEBELUM HAK MINORITAS (12 - 13)




NO.

a. ….…………………………………, 2 0(Tempat)




LAMPIRAN KHUSUS8B-4

SIMPANAN (GIRO DAN TABUNGAN WADIAH)

KEWAJIBAN LAIN (HUTANG SALAM DAN HUTANG

ISTISHNA)

INVESTASI TIDAK TERIKAT BUKAN BANK (TABUNGAN

DAN DEPOSITO MUDHARABAH)


PERNYATAAN

URAIAN



(tgl) (bln) (thn)


NILAI (US$)URAIAN URAIAN NILAI (US$)

EFEK - EFEK

PIUTANG (MURABAHAH, SALAM, ISTISHNA, IJAROH DLL)

PEMBIAYAAN MUDHARABAH

PEMBIAYAAN MUSYAROKAH

PEMBIAYAAN YANG DITERIMA

KEUNTUNGAN YANG SUDAH DIUMUMKAN BELUM

DIBAGI

INVESTASI TIDAK TERIKAT BANK (TABUNGAN DAN

DEPOSITO MUDHARABAH)



JUMLAH KEWAJIBAN, ITT DAN EKUITAS

NILAI (US$)





2 0DALAM MATA UANG DOLLAR AMERIKA SERIKAT

INSURANCE COMPANY 8A-5

TAXABLE YEAR

TIN :

TAXPAYER'S NAME :


NO. NO.

1. INVESTMENTS - TIME DEPOSITS 1. OBLIGATION TO POLICYHOLDER

2. INVESTMENTS IN SHARES OF STOCK 2. OBLIGATION FOR FUTURE POLICY BENEFITS

3. INVESTMENTS - BONDS 3. ESTIMATED OWN RETENTION CLAIMS

4. INVESTMENTS - TRADING SECURITIES 4. CLAIMS PAYABLE

5. INVESMENTS-DIRECT SHARE 5.

6. INVESTMENTS- LAND AND BUILDING 6.

7. INVESTMENTS- MORTGAGES LOAN 7. DEPOSIT PREMIUMS

8. INVESTMENTS- INSURANCE POLICY LOANS 8. COMMISION PAYABLES

9. OTHER INVESTMENTS 9. RE-INSURANCE PAYABLES

10. CASH ON HAND AND IN BANKS 10. ACCRUED EXPENSES

11. PREMIUM RECEIVABLES 11. TAXES PAYABLE

12. RE-INSURANCE RECEIVABLES 12. DEFFERED TAX LIABILITIES

13. INVESTMENT RETURN RECEIVABLES 13. OTHER LIABILITIES

14. OTHER ACCOUNT RECEIVABLES 14. CAPITAL STOCK

15. PREPAID EXPENSES 15. ADDITIONAL PAID-IN CAPITAL

16. DEFFERED TAX ASSETS 16.

17. FIXED ASSETS 17.


19. DEFERRED ACQUISITION COST – NET 19. RETAINED EARNINGS


TOTAL ASSETS


NO.

1. GROSS PREMIUMS

2. REINSURANCE PREMIUMS

3. DECREASE (INCREASE) IN UNEARNED PREMIUMS

4. TOTAL PREMIUMS INCOME (1 + 2 + 3)

5. NET INCOME FROM INVESTMENTS

6. OTHERS

7. TOTAL INCOME (4 + 5 + 6)

8. CLAIMS AND BENEFITS

9. RE-INSURANCE CLAIMS

10. INCREASE IN FUTURE POLICYHOLDER BENEFIT LIABILITIES AND ESTIMATED CLAIMS LIABILITIES

11. ACQUISITION COST

12. OPERATING EXPENSES


14. GENERAL AND ADMINISTRATIVE EXPENSE

15. OTHER EXPENSES

16. TOTAL EXPENSES (TOTAL 8 TO 15)

17. INCOME FROM OPERATIONS (7 - 16)


19. INCOME BEFORE INCOME TAX BENEFIT/(EXPENSE)(17+ 18)


21. GAINS (LOSSES) FROM NORMAL ACTIVITIES (19 - 20)


23. INCOME BEFORE MINORITY INTEREST IN NET EARNIGS OF SUBSIDIARIES (21 + 22)

24. MINORITY INTEREST IN NET EARNIGSSOF SUBSIDIARIES

25. NET PROFIT (23 - 24)


NO.

2 0a. ….…………………………………,

(Place)




2 0

VALUE (IDR)

VALUE (IDR)





DECLARATION

DESCRIPTION


NET UNREALIZED GAIN (LOSS) ON INCREASE (DECREASE) IN FAIR VALUE OF AVAILABLE FOR SALE SECURITIES

DIFFERENCE ON REVALUATION OF FIXED ASSET

DIFFERENCE IN VALUE RESULTING FROM RESTUCTURING TRANSACTION WITH ENTITIES UNDER COMMON CONTROL

TOTAL OBLIGATION TO POLICYHOLDER

DESCRIPTION

UNEARNED PREMIUMS


SPECIAL ATTACHMENT


PERUSAHAAN 8A-5

ASURANSI TAHUN PAJAK

NPWP :

NAMA WAJIB PAJAK :


NO. NO.

1. INVESTASI DEPOSITO 1. KEWAJIBAN KEPADA PEMEGANG POLIS

2. INVESTASI SAHAM 2. KEWAJIBAN MANFAAT POLIS MASA DEPAN

3. INVESTASI OBLIGASI 3. ESTIMASI KEWAJIBAN KLAIM

4. INVESTASI SURAT BERHARGA PASAR UANG 4. HUTANG KLAIM

5. INVESTASI PENYERTAAN LANGSUNG 5.

6. INVESTASI TANAH DAN BANGUNAN 6.

7. INVESTASI PINJAMAN HIPOTIK 7. TITIPAN PREMI

8. INVESTASI PINJAMAN POLIS 8. HUTANG KOMISI

9. INVESTASI LAINNYA 9. HUTANG REASURANSI

10. KAS DAN BANK 10. BIAYA MASIH HARUS DIBAYAR

11. PIUTANG PREMI 11. HUTANG PAJAK

12. PIUTANG REASURANSI 12. KEWAJIBAN PAJAK TANGGUHAN

13. PIUTANG HASIL INVESTASI 13. KEWAJIBAN LAIN-LAIN

14. PIUTANG LAIN-LAIN 14. MODAL SAHAM

15. BIAYA DIBAYAR DI MUKA 15. TAMBAHAN MODAL DISETOR


17. AKTIVA TETAP 17.


19. BIAYA AKUISISI DITANGGUHKAN – BERSIH 19. SALDO LABA


JUMLAH AKTIVA


NO.

1. PREMI BRUTO

2. PREMI REASURANSI

3. PENURUNAN (KENAIKAN) PREMI YANG BELUM MERUPAKAN PENDAPATAN

4. JUMLAH PENDAPATAN PREMI (1 + 2 + 3)

5. HASIL INVESTASI - BERSIH

6. LAIN-LAIN

7. JUMLAH PENDAPATAN (4 + 5 + 6)

8. KLAIM DAN MANFAAT

9. KLAIM REASURANSI

10. KENAIKAN KEWAJIBAN MANFAAT POLIS MASA DEPAN DAN ESTIMASI KEWAJIBAN KLAIM

11. BIAYA AKUISISI

12. BEBAN USAHA

13. PEMASARAN

14. UMUM DAN ADMINISTRASI

15. LAIN-LAIN

16. JUMLAH BEBAN (JUMLAH 8 S.D. 15)

17. LABA/RUGI USAHA (7 - 16)


19. LABA/RUGI SEBELUM PAJAK PENGHASILAN (17 + 18)



22. POS LUAR BIASA





NO.

a. ….…………………………………, 2 0(Tempat)




LAMPIRAN KHUSUS

JUMLAH KEWAJIBAN KEPADA PEMEGANG POLIS

SELISIH PENILAIAN KEMBALI AKTIVA TETAP

SELISIH NILAI TRANSAKSI RESTRUKTURISASI

ENTITAS SEPENGENDALI

LABA BELUM DIREALISASI DARI EFEK TERSEDIA

UNTUK DIJUAL


URAIAN

PERNYATAAN




(tgl) (bln) (thn)



NILAI (RUPIAH)


PREMI YANG BELUM MERUPAKAN

PENDAPATAN



INSURANCE COMPANY 8B-5

TAXABLE YEAR

TIN :

TAXPAYER'S NAME :


NO. NO.

1. INVESTMENTS - TIME DEPOSITS 1. OBLIGATION TO POLICYHOLDER

2. INVESTMENTS IN SHARES OF STOCK 2. OBLIGATION FOR FUTURE POLICY BENEFITS

3. INVESTMENTS - BONDS 3. ESTIMATED OWN RETENTION CLAIMS

4. INVESTMENTS - TRADING SECURITIES 4. CLAIMS PAYABLE

5. INVESMENTS-DIRECT SHARE 5.

6. INVESTMENTS- LAND AND BUILDING 6.

7. INVESTMENTS- MORTGAGES LOAN 7. DEPOSIT PREMIUMS

8. INVESTMENTS- INSURANCE POLICY LOANS 8. COMMISION PAYABLES

9. OTHER INVESTMENTS 9. RE-INSURANCE PAYABLES

10. CASH ON HAND AND IN BANKS 10. ACCRUED EXPENSES

11. PREMIUM RECEIVABLES 11. TAXES PAYABLE

12. RE-INSURANCE RECEIVABLES 12. DEFFERED TAX LIABILITIES

13. INVESTMENT RETURN RECEIVABLES 13. OTHER LIABILITIES

14. OTHER ACCOUNT RECEIVABLES 14. CAPITAL STOCK

15. PREPAID EXPENSES 15. ADDITIONAL PAID-IN CAPITAL

16. DEFFERED TAX ASSETS 16.

17. FIXED ASSETS 17.


19. DEFERRED ACQUISITION COST – NET 19. RETAINED EARNINGS


TOTAL ASSETS


NO.

1. GROSS PREMIUMS

2. REINSURANCE PREMIUMS

3. DECREASE (INCREASE) IN UNEARNED PREMIUMS

4. TOTAL PREMIUMS INCOME (1 + 2 + 3)

5. NET INCOME FROM INVESTMENTS

6. OTHERS

7. TOTAL INCOME (4 + 5 + 6)

8. CLAIMS AND BENEFITS

9. RE-INSURANCE CLAIMS

10. INCREASE IN FUTURE POLICYHOLDER BENEFIT LIABILITIES AND ESTIMATED CLAIMS LIABILITIES

11. ACQUISITION COST

12. OPERATING EXPENSES


14. GENERAL AND ADMINISTRATIVE EXPENSE

15. OTHER EXPENSES

16. TOTAL EXPENSES (TOTAL 8 TO 15)

17. INCOME FROM OPERATIONS (7 - 16)


19. INCOME BEFORE INCOME TAX BENEFIT/(EXPENSE)(17+ 18)


21. GAINS (LOSSES) FROM NORMAL ACTIVITIES (19 - 20)


23. INCOME BEFORE MINORITY INTEREST IN NET EARNIGS OF SUBSIDIARIES (21 + 22)

24. MINORITY INTEREST IN NET EARNIGSSOF SUBSIDIARIES

25. NET PROFIT (23 - 24)


NO.

2 0a. ….…………………………………,

(Place)




SPECIAL ATTACHMENT



DESCRIPTION

UNEARNED PREMIUMS

TOTAL OBLIGATION TO POLICYHOLDER

DIFFERENCE ON REVALUATION OF FIXED ASSET

DIFFERENCE IN VALUE RESULTING FROM RESTUCTURING TRANSACTION WITH ENTITIES UNDER COMMON CONTROL

NET UNREALIZED GAIN (LOSS) ON INCREASE (DECREASE) IN FAIR VALUE OF AVAILABLE FOR SALE SECURITIES

DESCRIPTION



DECLARATION





2 0

VALUE (US$)

VALUE (US$)

PERUSAHAAN 8B-5

ASURANSI TAHUN PAJAK

NPWP :

NAMA WAJIB PAJAK :


NO. NO.

1. INVESTASI DEPOSITO 1. KEWAJIBAN KEPADA PEMEGANG POLIS

2. INVESTASI SAHAM 2. KEWAJIBAN MANFAAT POLIS MASA DEPAN

3. INVESTASI OBLIGASI 3. ESTIMASI KEWAJIBAN KLAIM

4. INVESTASI SURAT BERHARGA PASAR UANG 4. HUTANG KLAIM

5. INVESTASI PENYERTAAN LANGSUNG 5.

6. INVESTASI TANAH DAN BANGUNAN 6.

7. INVESTASI PINJAMAN HIPOTIK 7. TITIPAN PREMI

8. INVESTASI PINJAMAN POLIS 8. HUTANG KOMISI

9. INVESTASI LAINNYA 9. HUTANG REASURANSI

10. KAS DAN BANK 10. BIAYA MASIH HARUS DIBAYAR

11. PIUTANG PREMI 11. HUTANG PAJAK

12. PIUTANG REASURANSI 12. KEWAJIBAN PAJAK TANGGUHAN

13. PIUTANG HASIL INVESTASI 13. KEWAJIBAN LAIN-LAIN

14. PIUTANG LAIN-LAIN 14. MODAL SAHAM

15. BIAYA DIBAYAR DI MUKA 15. TAMBAHAN MODAL DISETOR


17. AKTIVA TETAP 17.


19. BIAYA AKUISISI DITANGGUHKAN – BERSIH 19. SALDO LABA


JUMLAH AKTIVA


NO.

1. PREMI BRUTO

2. PREMI REASURANSI

3. PENURUNAN (KENAIKAN) PREMI YANG BELUM MERUPAKAN PENDAPATAN

4. JUMLAH PENDAPATAN PREMI (1 + 2 + 3)

5. HASIL INVESTASI - BERSIH

6. LAIN-LAIN

7. JUMLAH PENDAPATAN (4 + 5 + 6)

8. KLAIM DAN MANFAAT

9. KLAIM REASURANSI

10. KENAIKAN KEWAJIBAN MANFAAT POLIS MASA DEPAN DAN ESTIMASI KEWAJIBAN KLAIM

11. BIAYA AKUISISI

12. BEBAN USAHA

13. PEMASARAN

14. UMUM DAN ADMINISTRASI

15. LAIN-LAIN

16. JUMLAH BEBAN (JUMLAH 8 S.D. 15)

17. LABA/RUGI USAHA (7 - 16)


19. LABA/RUGI SEBELUM PAJAK PENGHASILAN (17 + 18)



22. POS LUAR BIASA





NO.

a. ….…………………………………, 2 0(Tempat)




LAMPIRAN KHUSUS



JUMLAH KEWAJIBAN KEPADA PEMEGANG POLIS

SELISIH PENILAIAN KEMBALI AKTIVA TETAP

SELISIH NILAI TRANSAKSI RESTRUKTURISASI

ENTITAS SEPENGENDALI

LABA BELUM DIREALISASI DARI EFEK TERSEDIA

UNTUK DIJUAL


URAIAN

PERNYATAAN




(tgl) (bln) (thn)



BAGI WAJIB PAJAK YANG DIIZINKAN MENYELENGGARAKAN PEMBUKUAN 2 0

URAIAN NILAI (US$)

PREMI YANG BELUM MERUPAKAN

PENDAPATAN

URAIAN NILAI (US$)

NILAI (US$)

NON- 8A-6 QUALIFICATION

TAXABLE YEAR

TIN :

TAXPAYER'S NAME :


NO. NO.

1. CASH AND EQUIVALENT 1. ACCOUNT PAYABLE - THIRD PARTY

2. TEMPORARY INVESTMENT 2.


4. 4. INTEREST TAXES

5. OTHER ACCOUNT RECEIVABLE - THIRD PARTIES 5. DIVIDEND PAYABLE


7. ALLOWANCE FOR DOUBTFUL ACCOUNTS 7. BANK PAYABLES

8. INVENTORIES 8.


10. PURCHASING DOWN PAYMENT 10. OTHER CURRENT LIABILITIES

11. OTHER CURRENT ASSETS 11. LONG - TERM DEBT-BANK LOANS

12. LONG - TERM RECEIVABLE 12.

13. LAND AND BUILDING 13.

14. OTHER FIXED ASSETS 14. DEFERRED TAX LIABILITIES

15. ACCUMULATED DEPRECIATION 15. OTHER NON CURRENT LIABILITIES

16. INVESTMENT IN ASSOCIATION COMPANIES 16. CAPITAL STOCK



19. DEFERRED TAX ASSETS 19. RETAINED EARNINGS

20. OTHER NON CURRENT ASSETS 20. OTHER EQUITY

TOTAL ASSETS


NO.

1. NET SALES


3. PURCHASE

4. ENDING INVENTORY



7. SALES EXPENSE

8. GENERAL AND ADMINISTRATION EXPENSE

9. PROFIT (6 - 7 - 8)

10. INCOME/ (EXPENSE) OTHER

11. NET EARNINGS FROM ASSOCIATES


13. INCOME TAX BENEFIT( EXPENSE)

14. GAIN (LOSS) FROM NORMAL ACTIVITIES (12 - 13)



17. MINORITY INTEREST IN NET EARNING OF SUBSIDIARIES

18. NET PROFIT (16 - 17)


NO.

2 0a. ….…………………………………,

(Place)




2 0TRANSCRIPT OF ELEMENTS CITATION OF

FINANCIAL STATEMENT

SPECIAL ATTACHMENT

DESCRIPTION

VALUE (IDR)

TOTAL LIABILITY AND OWNER'S EQUITY

DESCRIPTION


RETAINED EARNING FROM PREVIOUS YEAR

DESCRIPTION VALUE (IDR) VALUE (IDR)



OTHER RECEIVABLE WITH RELATED PARTIES

LONG -TERM DEBT-RELATED PARTIES


DECLARATION





LONG - TERM DEBT-THIRD PARTIES

NON- 8A-6

KUALIFIKASI TAHUN PAJAK

NPWP :

NAMA WAJIB PAJAK :


NO. NO.




4. 4. HUTANG PAJAK




8. PERSEDIAAN 8.







15. AKUMULASI PENYUSUTAN 15. KEWAJIBAN TIDAK LANCAR LAINNYA






JUMLAH AKTIVA


NO.

1. PENJUALAN BERSIH

2. PERSEDIAAN AWAL

3. PEMBELIAN

4. PERSEDIAAN AKHIR



7. BEBAN PENJUALAN


9. LABA USAHA (6 - 7 - 8)






15. POS LUAR BIASA





NO.

a. ….…………………………………, 2 0(Tempat)





PERNYATAAN



(tgl) (bln) (thn)






ISTIMEWA


ISTIMEWA

URAIAN NILAI (RUPIAH) NILAI (RUPIAH)


HUBUNGAN ISTIMEWA







LAMPIRAN KHUSUS

URAIAN



NON- 8B-6 QUALIFICATION

TAXABLE YEAR

TIN :

TAXPAYER'S NAME :


NO. NO.

1. CASH AND EQUIVALENT 1. ACCOUNT PAYABLE - THIRD PARTY

2. TEMPORARY INVESTMENT 2.


4. 4. INTEREST TAXES

5. OTHER ACCOUNT RECEIVABLE - THIRD PARTIES 5. DIVIDEND PAYABLE


7. ALLOWANCE FOR DOUBTFUL ACCOUNTS 7. BANK PAYABLES

8. INVENTORIES 8.


10. PURCHASING DOWN PAYMENT 10. OTHER CURRENT LIABILITIES

11. OTHER CURRENT ASSETS 11. LONG - TERM DEBT-BANK LOANS

12. LONG - TERM RECEIVABLE 12.


14. OTHER FIXED ASSETS 14. DEFERRED TAX LIABILITIES

15. ACCUMULATED DEPRECIATION 15. OTHER NON CURRENT LIABILITIES

16. INVESTMENT IN ASSOCIATION COMPANIES 16. CAPITAL STOCK



19. DEFERRED TAX ASSETS 19. RETAINED EARNINGS

20. OTHER NON CURRENT ASSETS 20. OTHER EQUITY

TOTAL ASSETS


NO.

1. NET SALES


3. PURCHASE

4. ENDING INVENTORY



7. SALES EXPENSE

8. GENERAL AND ADMINISTRATION EXPENSE

9. PROFIT (6 - 7 - 8)

10. INCOME/ (EXPENSE) OTHER

11. NET EARNINGS FROM ASSOCIATES


13. INCOME TAX BENEFIT( EXPENSE)

14. GAIN (LOSS) FROM NORMAL ACTIVITIES (12 - 13)



17. MINORITY INTEREST IN NET EARNING OF SUBSIDIARIES

18. NET PROFIT (16 - 17)


NO.

2 0a. ….…………………………………,

(Place)




LONG - TERM DEBT-THIRD PARTIES

DECLARATION




LONG -TERM DEBT-RELATED PARTIES



OTHER RECEIVABLE WITH RELATED PARTIES

DESCRIPTION VALUE (US$) VALUE (US$)



RETAINED EARNING FROM PREVIOUS YEAR

TOTAL LIABILITY AND OWNER'S EQUITY


SPECIAL ATTACHMENT

DESCRIPTION


2 0FOR CORPORATION PERMITTED TO MAINTAIN BOOKKEEPING IN ENGLISH LANGUAGE AND UNITED STATE DOLLAR CURRENCY


NON- 8B-6

KUALIFIKASI TAHUN PAJAK

NPWP :

NAMA WAJIB PAJAK :


NO. NO.




4. 4. HUTANG PAJAK




8. PERSEDIAAN 8.







15. AKUMULASI PENYUSUTAN 15. KEWAJIBAN TIDAK LANCAR LAINNYA






JUMLAH AKTIVA


NO.

1. PENJUALAN BERSIH

2. PERSEDIAAN AWAL

3. PEMBELIAN

4. PERSEDIAAN AKHIR



7. BEBAN PENJUALAN


9. LABA USAHA (6 - 7 - 8)






15. POS LUAR BIASA





NO.

a. ….…………………………………, 2 0(Tempat)





PERNYATAAN



(tgl) (bln) (thn)






ISTIMEWA


ISTIMEWA

URAIAN NILAI (US$) NILAI (US$)


HUBUNGAN ISTIMEWA






URAIAN NILAI (US$)

LAMPIRAN KHUSUS

URAIAN




BAGI WAJIB PAJAK YANG DIIZINKAN MENYELENGGARAKAN PEMBUKUAN 2 0

8A-7

TAXABLE YEAR

TIN :

TAXPAYER'S NAME :


NO. NO.

INVESTMENT (Acquisition Cost) 1. ACTUARIAL LIABILITIES

1. DEPOSIT ON CALL 2.

2. TIME DEPOSIT NON ACTUARIAL LIABILITIES

3. 3. MATURE PENSION BENEFIT DEBTS

4. CERTIFICATES OF CENTRAL BANK 4. INVESTMENT PAYABLE

5. 5. PREPAID INCOME

6. BOND 6. ACCRUED EXPENSE

7. INVESTMENT IN MUTUAL FUND UNIT 7.

8. GOVERNMENT SECURITIES

9. COLLECTIVE INVESTMENT UNIT

10. DIRECT PLACEMENT

11. LETTER OF DEBT

12. LAND AND BUILDING (Net)

13. OTHER ALLOWED INVESTMENT

14. DIFFRENCE ON INVESTMENT CURRENT ASSETS

NON INVESTMENT CURRENT ASSETS

15. CASH AND BANK

16. CONTRIBUTIONS - NORMAL EMPLOYEE

17. CONTRIBUTIONS - NORMAL PARTICIPANT

18. CONTRIBUTIONS - ADDITIONAL PARTICIPANT

19. LATE PREMIUM INTEREST RECEIVABLE

20. PREPAID EXPENSE

21. INVESTMENT RECEIVABLE

22. INVESTMENT REVENUE RECEIVABLE

23. OTHER RECEIVABLE

OPERATING ASSETS


25. OTHER OPERATING ASSETS (Net)

TOTAL ASSETS

II. ELEMENT FROM INCOME STATEMENT

NO.

1. INVESTMENT EARNING

2. INVESTMENT EXPENSE

3. RETURN ON INVESTMENT (1 - 2)

OPERATING EXPENSES :

4. SALARY/HONORARIUM OF EMPLOYEE , MANAGEMENT AND SUPERVISORY BOARD

5. OFFICE EXPENSES

6. MAINTENANCE EXPENSES

7. DEPRECIATION EXPENSES

8. EXPENSES OF THIRD PARTY'S SERVICE


10. TOTAL OPERATING EXPENSES (4 + 5 + 6 + 7 + 8 + 9)

11. OTHER INCOMES

12. OTHER EXPENSES

13. NET PROFIT (3 - 10 + 11 - 12)


NO.

a. ….…………………………………, 2 0(Place)

b. TAXPAYER AUTHORIZED/REPRESENTATIF

c. FULL NAME OF MANAGEMENT/REPRESENTATIF

8A-7 PENSION FUNDSPECIAL ATTACHMENT


2 0

DESCRIPTION VALUE (IDR) DESCRIPTION VALUE(IDR)


CERTIFICATE ON DEPOSIT

DIFFERENCE ON ACTUARIAL LIABILITIS

SHARE

OTHER NON ACTUARIAL LIABILITIES

TOTAL LIABILITES AND EQUITIES

DESCRIPTON VALUE (IDR)



DECLARATION



8A-7

TAHUN PAJAK

NPWP :

NAMA WAJIB PAJAK :


NO. NO.

INVESTASI (Harga Perolehan) 1. KEWAJIBAN AKTUARIA

1. DEPOSITO ON CALL 2.

2. DEPOSITO BERJANGKA KEWAJIBAN DILUAR KEWAJIBAN AKTUARIA

3. 3. HUTANG MANFAAT PENSIUN JATUH TEMPO

4. SERTIFIKAT BANK INDONESIA (SBI) 4. UTANG INVESTASI

5. 5. PENDAPATAN DITERIMA DIMUKA

6. OBLIGASI 6. BEBAN YANG MASIH HARUS DIBAYAR

7. UNIT PENYERTAAN REKSADANA 7.

8. SURAT BERHARGA PEMERINTAH

9. UNIT PENYERTAAN INVESTASI KOLEKTIF

10. PENEMPATAN LANGSUNG

11. SURAT PENGAKUAN UTANG

12. TANAH DAN BANGUNAN (Neto)

13. INVESTASI LAIN YANG DIPERKENANKAN

14. SELISIH PENELAIAN INVESTASI

AKTIVA LANCAR DILUAR INVESTASI

15. KAS & BANK

16. PIUTANG - IURAN NORMAL PEMBERI KERJA

17. PIUTANG - IURANG NORMAL PESERTA

18. PIUTANG - IURAN TAMBAHAN

19. PIUTANG BUNGA KETERLAMBATAN IURAN

20. BEBAN DIBAYAR DIMUKA

21. PIUTANG INVESTASI

22. PIUTANG HASIL INVESTASI

23. PIUTANG LAIN-LAIN

AKTIVA OPERASIONAL


25. AKTIVA OPERASIONAL LAIN (Neto)

JUMLAH AKTIVA


NO.

1. PENDAPATAN INVESTASI

2. BEBAN INVESTASI

3. HASIL USAHA INVESTASI (1 - 2)

BEBAN OPERASIONAL :

4. GAJI/HONOR KARYAWAN, PENGURUS DAN DEWAN PENGAWAS

5. BEBAN KANTOR

6. BEBAN PEMELIHARAAN

7. BEBAN PENYUSUTAN

8. BEBAN JASA PIHAK KETIGA

9. BEBAN OPERASIONAL LAIN

10. TOTAL BEBAN OPERASIONAL (4 + 5 + 6 + 7 + 8 + 9)

11. PENDAPATAN LAIN-LAIN

12. BEBAN LAIN-LAIN

13. LABA BERSIH (3 - 10 + 11 - 12)


NO.

a. ….…………………………………, 2 0(Tempat)



8A-7 DANA PENSIUNLAMPIRAN KHUSUS





SELISIH KEWAJIBAN AKTUARIA

SERTIFIKAT DEPOSITO

SAHAM

KEWAJIBAN DILUAR KEWAJIBAN AKTUARIA LAIN




PERNYATAAN



(tgl) (bln) (thn)


8B-7

TAXABLE YEAR

TIN :

TAXPAYER'S NAME :


NO. NO.

INVESTMENT (Acquisition Cost) 1. ACTUARIAL LIABILITIES

1. DEPOSIT ON CALL 2.

2. TIME DEPOSIT NON ACTUARIAL LIABILITIES

3. 3. MATURE PENSION BENEFIT DEBTS

4. CERTIFICATES OF CENTRAL BANK 4. INVESTMENT PAYABLE

5. 5. PREPAID INCOME

6. BOND 6. ACCRUED EXPENSE

7. INVESTMENT IN MUTUAL FUND UNIT 7.

8. GOVERNMENT SECURITIES

9. COLLECTIVE INVESTMENT UNIT

10. DIRECT PLACEMENT

11. LETTER OF DEBT


13. OTHER ALLOWED INVESTMENT

14. DIFFRENCE ON INVESTMENT APPRAISAL

NON INVESTMENT CURRENT ASSETS

15. CASH AND BANK

16. CONTRIBUTIONS - NORMAL EMPLOYEE

17. CONTRIBUTIONS - NORMAL PARTICIPANT

18. CONTRIBUTIONS - ADDITIONAL PARTICIPANT

19. LATE PREMIUM INTEREST RECEIVABLE

20. PREPAID EXPENSE

21. INVESTMENT RECEIVABLE

22. INVESTMENT REVENUE RECEIVABLE

23. OTHER RECEIVABLE

OPERATING ASSETS


25. OTHER OPERATING ASSETS (Net)

TOTAL ASSETSTOTA


NO.

1. INVESTMENT EARNING

2. INVESTMENT EXPENSE

3. RETURN ON INVESTMENT (1 - 2)


4. SALARY/HONORARIUM OF EMPLOYEE , MANAGEMENT AND SUPERVISORY BOARD

5. OFFICE EXPENSES

6. MAINTENANCE EXPENSES

7. DEPRECIATION EXPENSES

8. EXPENSES OF THIRD PARTY'S SERVICE


10. TOTAL OPERATING EXPENSES (4 + 5 + 6 + 7 + 8 + 9)

11. OTHER INCOMES

12. OTHER EXPENSES

13. NET PROFIT (3 - 10 + 11 - 12)


NO.

a. ….…………………………………, 2 0(Place)






DECLARATION


DESCRIPTON VALUE (RUPIAH)

OTHER NON ACTUARIAL LIABILITIES

CERTIFICATE ON DEPOSIT

SHARE

DIFFERENCE ON ACTUARIAL LIABILITIES

DESCRIPTION VALUE (US$) DESCRIPTION VALUE(US$)


8B-7 PENSION FUNDSPECIAL ATTACHMENT


2 0

FOR TAXPAYER PERMITTED TO MAINTAIN BOOKS OF ACCOUNT IN ENGLISH LANGUAGE AND UNITED STATED DOLLAR CURRENCY

8B-7

TAHUN PAJAK

NPWP :

NAMA WAJIB PAJAK :


NO. NO.

INVESTASI (Harga Perolehan) 1. KEWAJIBAN AKTUARIA

1. DEPOSITO ON CALL 2.

2. DEPOSITO BERJANGKA KEWAJIBAN DILUAR KEWAJIBAN AKTUARIA

3. 3. HUTANG MANFAAT PENSIUN JATUH TEMPO

4. SERTIFIKAT BANK INDONESIA (SBI) 4. UTANG INVESTASI

5. 5. PENDAPATAN DITERIMA DIMUKA

6. OBLIGASI 6. BEBAN YANG MASIH HARUS DIBAYAR

7. UNIT PENYERTAAN REKSADANA 7.

8. SURAT BERHARGA PEMERINTAH

9. UNIT PENYERTAAN INVESTASI KOLEKTIF

10. PENEMPATAN LANGSUNG

11. SURAT PENGAKUAN UTANG


13. INVESTASI LAIN YANG DIPERKENANKAN

14. SELISIH PENELAIAN INVESTASI

AKTIVA LANCAR DILUAR INVESTASI

15. KAS & BANK

16. PIUTANG - IURAN NORMAL PEMBERI KERJA

17. PIUTANG - IURANG NORMAL PESERTA

18. PIUTANG - IURAN TAMBAHAN

19. PIUTANG BUNGA KETERLAMBATAN IURAN

20. BEBAN DIBAYAR DIMUKA

21. PIUTANG INVESTASI

22. PIUTANG HASIL INVESTASI

23. PIUTANG LAIN-LAIN

AKTIVA OPERASIONAL


25. AKTIVA OPERASIONAL LAIN (Neto)

JUMLAH AKTIVA


NO.

1. PENADAPATAN INVESTASI

2. BEBAN INVESTASI

3. HASIL USAHA INVESTASI (1 - 2)

BEBAN OPERASIONAL :

4. GAJI/HONOR KARYAWAN, PENGURUS DAN DEWAN PENGAWAS

5. BEBAN KANTOR

6. BEBAN PEMELIHARAAN

7. BEBAN PENYUSUTAN

8. BEBAN JASA PIHAK KETIGA

9. BEBAN OPERASIONAL LAIN

10. TOTAL BEBAN OPERASIONAL (4 + 5 + 6 + 7 + 8 + 9)

11. PENDAPATAN LAIN-LAIN

12. BEBAN LAIN-LAIN

13. LABA BERSIH (3 - 10 + 11 - 12)


NO.

a. ….…………………………………, 2 0(Tempat)




URAIAN

8B-7LAMPIRAN KHUSUS


BAGI WAJIB PAJAK YANG DIIZINKAN MENYELENGGARAKAN PEMBUKUAN DALAM MATA UANG DOLLAR AMERIKA

SERIKAT

DANA PENSIUN

KEWAJIBAN DILUAR KEWAJIBAN AKTUARIA LAIN



SAHAM

2 0TRANSKRIP KUTIPAN ELEMEN-ELEMEN


NILAI (US$) URAIAN NILAI (US$)

SELISIH KEWAJIBAN AKTUARIA

SERTIFIKAT DEPOSITO


PERNYATAAN



(tgl) (bln) (thn)

FINANCING 8A-8

COMPANY TAXABLE YEAR

TIN :

TAXPAYER'S NAME :


NO. NO.

CASH AND EQUIVALENT 1. LIABILITIES PAID IMMEDIATELY

1. CASH 2.

2. DOMESTIC BANK LOANS

3. 3. DOMESTIC

4. SHORT-TERM INVESTMENT IN SECURITIES 4. FOREIGN

5. SECURITIES ISSUED

5. LEASING 6. LIABILITIES OF DEFERRED TAX

6. FACTORING

7. CREDIT CARD 7. DOMESTIC

8. CONSUMEN FINANCE 8. FOREIGN

CAPITAL INVESTMENTS 9. OTHER LIABILITIES

9. BANK

10. OTHER FINANCE SERVICE COMPANY 10.

11. LONG-TERM INVESMENT IN SECURITIES 11. PREMIUM

12. OPERATING LEASE - NET 12. DISAGIO

FIXED ASSET AND INVENTORY - NET 13. COMMERCIAL RESERVE


14. FIXED ASSET OTHER THAN LAND AND BUILDING 15.

15. DEFFERED TAX ASSET 16. BALANCE- GAIN (LOSS)

16. OTHER ASSETS 17. GAIN (LOSSI) IN CURRENT YEAR

TOTAL ASSETS


NO.

OPERATING INCOME :

1. LEASING

2. FACTORING

3. CREDIT CARD

4. CONSUMEN FINANCING

5. INCOME FROM FINANCING DISTRIBUTION

6. TOTAL OPERATING INCOME (1 + 2 + 3 + 4 + 5)


7. INTEREST

8. SWAP PREMIUMS

9. INSURANCE PREMIUMS

10. MANPOWER

11. DEPRECIATION

12. RECEIVABLE WRITE OFF ON FINANCING

13. RENT


15. TOTAL OPERATING EXPENSES (7 + 8 + 9 + 10 + 11 + 12 + 13 + 14)

16. NON OPERATING INCOME

17. NON OPERATING EXPENSE

13. NET PROFIT (3 - 10 + 11 - 12)


NO.

a. ….…………………………………, 2 0(Place)



8A-8SPECIAL ATTACHMENT


2


TAX PAYABLE

0



BANK-OVERSEAS

FINANCING RECEIVABLE - NET

SUBORDINATED DEBT

CAPITAL

PAID IN CAPITAL

APPROPRIATED RESERVE

REVALUATION RESERVE





TYPES OF TRANSACTION TRANSACTION VALUE (IDR)

DECLARATION

PARTIES

PERUSAHAAN 8A-8

PEMBIAYAAN TAHUN PAJAK

NPWP :

NAMA WAJIB PAJAK :


NO. NO.

KAS DAN SETARA KAS 1. KEWAJIBAN YANG SEGERA DIBAYAR

1. KAS 2.

2. BANK DALAM NEGERI PINJAMAN YANG DITERIMA

3. 3. DALAM NEGERI

4. INVESTASI JANGKA PENDEK DALAM SURAT BERHARGA 4. LUAR NEGERI

5. SURAT BERHARGA YANG DITERBITKAN

5. SEWA GUNA USAHA 6. KEWAJIBAN PAJAK TANGUHAN

6. ANJAK PIUTANG

7. KARTU KREDIT 7. DALAM NEGERI

8. PEMBIAYAAN KONSUMEN 8. LUAR NEGERI

PENYERTAAN MODAL 9. KEWAJIBAN LAINNYA

9. BANK

10. PERUSAHAAN JASA KEUANGAN LAINNYA 10.

11. INVESTASI JANGKA PANAJANG DALAM SURAT BERHARGA 11. AGIO

12. AKTIVA TETAP YANG DISEWAGUNAUSAHAKAN - NETO 12. DISAGIO

AKTIIVA TETAP DAN INVENTARIS - NETO 13. CADANGAN UMUM


14. AKTIVA TETAP SELAIN TANAH DAN BANGUNAN 15.

15. AKTIVA PAJAK TANGGUHAN 16. SALDO LABA (RUGI)

16. AKTIVA LAIN-LAIN 17. LABA (RUGI) TAHUN BERJALAN

JUMLAH AKTIVA


NO.

PENDAPATAN OPERASIONAL :

1. SEWA GUNA USAHA

2. ANJAK PIUTANG

3. KARTU KREDIT

4. PEMBIAYAAN KONSUMEN

5. PENDAPATAN DARI PENYALURAN PEMBIAAN

6. TOTAL PENDAPATAN OPERASIONAL (1 + 2 + 3 + 4 + 5)

BEBAN OPERASIONAL :

7. BUNGA

8. PREMI SWAP

9. PREMI ASURANSI

10. TENAGA KERJA

11. PENYUSUTAN

12. PENGHAPUSAN PIUTANG PEMBIAYAAN

13. SEWA

14. BIAYA OPERASIONAL LAIN

15. TOTAL BEBAN OPERASIONAL (7 + 8 + 9 + 10 + 11 + 12 + 13 + 14)

16. PENDAPATAN NON OPERASIONAL

17. BEBAN NON OPERASIONAL

13. LABA BERSIH (6 - 15 + 16 - 17)


NO.

a. ….…………………………………, 2 0(Tempat)



8A-8LAMPIRAN KHUSUS





UTANG PAJAK

BANK LUAR NEGERI

PIUTANG PEMBIAYAAN - NETO

PINJAMAN SUBORDINASI

MODAL

MODAL DISETOR

CADANGAN TUJUAN

CADANGAN REVALUASI AKTIVA TETAP



PERNYATAAN



(tgl) (bln) (thn)



FINANCING 8B-8

COMPANY

TAXABLE YEAR

TIN :

TAXPAYER'S NAME :


NO. NO.

CASH AND EQUIVALENT 1. LIABILITIES PAID IMMEDIATELY

1. CASH 2.

2. DOMESTIC BANK LOANS

3. 3. DOMESTIC

4. SHORT-TERM INVESTMENT IN SECURITIES 4. FOREIGN

5. SECURITIES ISSUED

5. LEASING 6. LIABILITIES OF DEFERRED TAX

6. FACTORING

7. CREDIT CARD 7. DOMESTIC

8. CONSUMEN FINANCE 8. FOREIGN

CAPITAL INVESTMENTS 9. OTHER LIABILITIES

9. BANK

10. OTHER FINANCE SERVICE COMPANY 10.

11. LONG-TERM INVESMENT IN SECURITIES 11. PREMIUM

12. OPERATING LEASE - NET 12. DISAGIO

FIXED ASSET AND INVENTORY - NET 13. COMMERCIAL RESERVE


14. FIXED ASSET OTHER THAN LAND AND BUILDING 15.

15. DEFFERED TAX ASSET 16. BALANCE- GAIN (LOSS)

16. OTHER ASSETS 17. GAIN (LOSSI) IN CURRENT YEAR

TOTAL ASSETS

II. ELEMEN DARI LAPORAN ELEMENT FROM INCOME STATEMENT

NO.

OPERATING INCOME :

1. LEASING

2. FACTORING

3. CREDIT CARD

4. CONSUMEN FINANCING

5. INCOME FROM FINANCING DISTRIBUTION

6. TOTAL OPERATING INCOME (1 + 2 + 3 + 4 + 5)


7. INTEREST

8. SWAP PREMIUMS

9. INSURANCE PREMIUMS

10. MANPOWER

11. DEPRECIATION

12. RECEIVABLE WRITE OFF ON FINANCING

13. RENT


15. TOTAL OPERATING EXPENSES (7 + 8 + 9 + 10 + 11 + 12 + 13 + 14)

16. NON OPERATING INCOME

17. NON OPERATING EXPENSE

13. NET PROFIT (3 - 10 + 11 - 12)


NO.

a. ….…………………………………, 2 0(Place)





TYPES OF TRANSACTION TRANSACTION VALUE (US$)

DECLARATION

PARTIES


DESCRIPTION VALUE (US $)

APPROPRIATED RESERVE

REVALUATION RESERVE

CAPITAL

PAID IN CAPITAL

SUBORDINATED DEBT

FINANCING RECEIVABLE - NET

BANK-OVERSEAS

0



8B-8SPECIAL ATTACHMENT

CORPORATE ANNUAL INCOME TAX RETURNFOR TAXPAYER PERMITTED TO MAINTAIN BOOKS OF ACCOUNT IN ENGLISH LANGUAGE AND UNITED STATED

DOLLAR CURRENCY

2


TAX PAYABLE

PERUSAHAAN 8B-8

PEMBIAYAAN

TAHUN PAJAK

NPWP :

NAMA WAJIB PAJAK :


NO. NO.

KAS DAN SETARA KAS 1. KEWAJIBAN YANG SEGERA DIBAYAR

1. KAS 2.

2. BANK DALAM NEGERI PINJAMAN YANG DITERIMA

3. 3. DALAM NEGERI

4. INVESTASI JANGKA PENDEK DALAM SURAT BERHARGA 4. LUAR NEGERI

5. SURAT BERHARGA YANG DITERBITKAN

5. SEWA GUNA USAHA 6. KEWAJIBAN PAJAK TANGUHAN

6. ANJAK PIUTANG

7. KARTU KREDIT 7. DALAM NEGERI

8. PEMBIAYAAN KONSUMEN 8. LUAR NEGERI

PENYERTAAN MODAL 9. KEWAJIBAN LAINNYA

9. BANK

10. PERUSAHAAN JASA KEUANGAN LAINNYA 10.

11. INVESTASI JANGKA PANAJANG DALAM SURAT BERHARGA 11. AGIO

12. AKTIVA TETAP YANG DISEWAGUNAUSAHAKAN - NETO 12. DISAGIO

AKTIIVA TETAP DAN INVENTARIS - NETO 13. CADANGAN UMUM


14. AKTIVA TETAP SELAIN TANAH DAN BANGUNAN 15.

15. AKTIVA PAJAK TANGGUHAN 16. SALDO LABA (RUGI)

16. AKTIVA LAIN-LAIN 17. LABA (RUGI) TAHUN BERJALAN

JUMLAH AKTIVA


NO.

PENDAPATAN OPERASIONAL :

1. SEWA GUNA USAHA

2. ANJAK PIUTANG

3. KARTU KREDIT

4. PEMBIAYAAN KONSUMEN

5. PENDAPATAN DARI PENYALURAN PEMBIAAN

6. TOTAL PENDAPATAN OPERASIONAL (1 + 2 + 3 + 4 + 5)

BEBAN OPERASIONAL :

7. BUNGA

8. PREMI SWAP

9. PREMI ASURANSI

10. TENAGA KERJA

11. PENYUSUTAN

12. PENGHAPUSAN PIUTANG PEMBIAYAAN

13. SEWA

14. BIAYA OPERASIONAL LAIN

15. TOTAL BEBAN OPERASIONAL (7 + 8 + 9 + 10 + 11 + 12 + 13 + 14)

16. PENDAPATAN NON OPERASIONAL

17. BEBAN NON OPERASIONAL

13. LABA BERSIH (3 - 10 + 11 - 12)


NO.

a. ….…………………………………, 2 0(Tempat)



8B-8LAMPIRAN KHUSUS


BAGI WAJIB PAJAK YANG DIIZINKAN MENYELENGGARAKAN PEMBUKUAN DALAM MATA UANG DOLLAR AMERIKA

SERIKAT




UTANG PAJAK

BANK LUAR NEGERI

PIUTANG PEMBIAYAAN - NETO

PINJAMAN SUBORDINASI

MODAL

MODAL DISETOR

CADANGAN TUJUAN

CADANGAN REVALUASI AKTIVA TETAP



PERNYATAAN



(tgl) (bln) (thn)



T I N : TAXPAYER'S NAME:


NO.

(1)

TOTAL

Notes:

• Filled with calculation of each Withholding Tax Receipt.

• Copy of Total Income Tax Article 22, Income Tax Article 23 and Income Tax Article 26 column (6) to Form 1771 Letter C Line 8.a.

Page- from page Attachment-III

D.1.1.32.32

WITHHOLDING AGENT

NAME

(2) (3)

TIN

(5)

(IDR)

(4)

WITHHOLDING OBJECT

TYPES OF INCOME/

TRANSACTION

1771 - III



TTL

(7)(6) (8)


DATE

TA

XA

BL

E Y

EA

R

WITHHOLDING RECEIPT/TAX PAYMENT SLIP (SSP)/SSPCP

MINISTRY OF FINANCE OF THE REPUBLIC OF

INDONESIA

(IDR)

INCOME TAX WITHHELD

FO

RM

FOREIGN TAX CREDIT

to

IDE

NT

ITY

ATTACHMENT - III

NUMBER

2 0A A


PERIODE PEMBUKUAN :

(1)

JUMLAH

Catatan :

• Diisi dengan rincian per Bukti Pemotongan / Pemungutan Pajak.

• Pindahkan hasil penjumlahan PPh Pasal 22, PPh Pasal 23 dan PPh Pasal 26 Kolom (6) ke Formulir 1771 Huruf C Angka 8.a.


D.1.1.32.32

s.d.

IDE

NT

ITA

S

LAMPIRAN - III

SPT TAHUNAN PAJAK PENGHASILAN WAJIB PAJAK BADANKEMENTERIAN KEUANGAN RI



JML

TA

HU

N P

AJA

K

FO

RM

UL

IR 1771 - III


NO.

(3)

OBJEK PEMOTONGAN / PEMUNGUTAN

JENIS PENGHASILAN /TANGGAL


NAMA NPWP

PAJAK PENGHASILAN

(2) (6)


NOMOR

(7) (8)

TRANSAKSI(Rupiah)

(4) (5)

YANG DIPOTONG / DIPUNGUT

(Rupiah)

2 0 A A


ACCOUNTING PERIOD :

(1)

Notes:

• Filled with calculation of each Withholding Tax Receipt.• Column (6) US$ filed with convertion value from the number in column (7) Rupiah, using Tax Rates which prevailing at the date of withholding• Copy of Total Income Tax Article 22, Income Tax Article 23 and Income Tax Article 26 column (6) to Form 1771/$ Letter C Line 8.a.

Pages- from page attachment-III

D.1.1.32.39

NAME TIN

WITHHOLDING AGENTNO.

TOTAL TTL

(5)

DIRECTORATE GENERAL OF TAXES FOREIGN TAX CREDIT

INCOME TAX WITHHELD


NUMBER

(2) (3)

WITHHOLDING OBJECT

(US$)TYPES OF INCOME/

(4)

WITHHOLDING RECEIPT/TAX PAYMENT SLIP (SSP/SPPCP)

FO

RM

IDE

NT

ITY

TA

XA

BL

E Y

EA

R

ATTACHMENT - IIICORPORATE ANNUAL INCOME TAX RETURN

to


1771 - III/$MINISTRY OF FINANCE OF THE REPUBLIC

OF INDONESIA

DATE

(9)(US$) (IDR)

(6) (7) (8)

2 0 A A


PERIODE PEMBUKUAN :

(1)

Catatan :

• Diisi dengan rincian per Bukti Pemotongan / Pemungutan Pajak.• Kolom (6) US$ diisi dengan nilai konversi dari angka dalam Kolom (7) Rupiah, dengan menggunakan Kurs Pajak yang berlaku pada tanggal Pemotongan/Pemungutan• Pindahkan hasil penjumlahan PPh Pasal 22, PPh Pasal 23 dan PPh Pasal 26 Kolom (6) ke Formulir 1771/$ Huruf C Angka 8.a.


D.1.1.32.39

4.

NOMOR

(8)

2.

3.

NO.

(7)

14.

13.

8.

9.

10.

7.

11.

12.

5.

6.

1.


TANGGAL

(9)

IDE

NT

ITA

SSPT TAHUNAN PAJAK PENGHASILAN WAJIB PAJAK BADAN



FO

RM

UL

IR 1771 - III/$KEMENTERIAN KEUANGAN RI


(6)


TA

HU

N P

AJA

K

LAMPIRAN - III


s.d.

NPWP

(2) (3) (4) (5)


NAMA

JUMLAH JML

PAJAK PENGHASILANYANG DIPOTONG / DIPUNGUT

(US$) (Rupiah)


TRANSAKSI (US$)

2 0A A



T I N :

TAXPAYER'S NAME :





D.1.1.32.35


T I NNAME ADDRESS

(2) (3) (4)


TA

XA

BL

E Y

EA

R

(1)

FO

RM 1771 - V

ATTACHMENT - V ANNUAL INCOME TAX RETURN FOR CORPORATE

to

IDE

NT

ITY

NO%

(2)

NAME ADDRESS T I N

(3) (4)

NO

(1)

DIVIDENDTOTAL PAID IN SHARES

(5)(IDR)

(7)(IDR)

(6)

(5)

POSITION

TPA

from


100%TOTAL PART A

2 0 A A



N P W P :

NAMA WAJIB PAJAK :

PERIODE PEMBUKUAN :


(1)

JBA


NO

(1)

Halaman ke- dari halaman Lampiran-V

D.1.1.32.35

TA

HU

N P

AJ

AK

LAMPIRAN - V



1771 - VF

OR

MU

LIR


s.d.

IDE

NT

ITA

S


100%


(Rupiah) %

DIVIDEN

(Rupiah)

(2) (3) (4) (5) (6) (7)

JUMLAH BAGIAN A

(2) (4) (5)

ALAMAT

(3)

NPWP JABATANNAMA

2 0A A



T I N :

TAXPAYER'S NAME :

ACCOUNTING PERIOD :


(3) (4)


(3) (4)


D.1.1.32.41



(6)

100%TPATOTAL PART A


to

TA

XA

BL

E Y

EA

R

(7)(US$)%

DIVIDEND

FO

RM

T I N

(2)

NAME ADDRESS

1771 - V/$MINISTRY OF FINANCE OF THE

REPUBLIC ON INDONESIA

NO

(1)

ATTACHMENT - V

TOTAL PAID IN SHARES(US$)

from

FOR CORPORATE PERMITTED TO MAINTAIN BOOKS IN ACCOUNT IN ENGLISH LANGUAGE AND US DOLLAR CURRENCY

IDE

NT

ITY

NO

(1)

(5)

POSITIONT I NNAME ADDRESS(2) (5)

2 0 A A



N P W P :

NAMA WAJIB PAJAK :

PERIODE PEMBUKUAN :


(1)

JBA


NO

(1)

Halaman ke- dari halaman Lampiran-V

D.1.1.32.41

10.

9.

8.

7.

6.

5.

4.

3.

2.

1.

NAMA ALAMAT NPWP JABATAN

(2) (3) (4) (5)

JUMLAH BAGIAN A

(5)(2) (3) (4)


(US$)

IDE

NT

ITA

S

s.d.

FO

RM

UL

IR

(US$)%

DIVIDEN

TA

HU

N P

AJ

AK



LAMPIRAN - V



1771 - V/$SPT TAHUNAN PAJAK PENGHASILAN WAJIB PAJAK BADAN

(7)


(6)

100%

2 0A A

• LIST OF CAPITAL CONTRIBUTION IN AFFILIATION COMPANIES

• LIST OF ACCOUNT PAYABLE FROM SHARESHOLDERS AND/OR AFFILIATION COMPANIES

• LIST OF ACCOUNT RECEIVABLE TO SHARESHOLDERS AND/OR AFFILIATION COMPANIES

T I N :

TAXPAYER'S NAME :


PART A : LIST OF CAPITAL CONTRIBUTION IN AFFILIATION COMPANIES

(1)

PART B : LIST OF ACCOUNT PAYABLE FROM SHARESHOLDER AND/OR AFFILIATION COMPANIES

(1)

PART C : LIST OF ACCOUNT RECEIVABLE TO SHARESHOLDER AND/OR AFFILIATION COMPANIES

(1)


D.1.1.32.36

TA

XA

BL

E Y

EA

R

FO

RM 1771 - VI

IDE

NT

ITY

to


ATTACHMENT - VI



NO%

ADDRESS T I NAMOUNT OF CAPITAL CONTRIBUTION

(IDR)NAME

(6)(2) (3) (4) (5)

TOTAL

NO NAME T I NTOTAL LOAN INTEREST/YR

(IDR) %

TTL

YEAR

(2) (3) (4) (5) (6)

(6)

INTEREST/YR

%

(4) (5)



YEAR(IDR)

from

(2) (3)

2 0 A A




N P W P :

NAMA WAJIB PAJAK :

PERIODE PEMBUKUAN :


(1)

JBA


(1)


(1)


D.1.1.32.36

IDE

NT

ITA

S

s.d.

NO NAMA ALAMAT

(2)

NPWP

(4)

LAMPIRAN - VI

TA

HU

N P

AJ

AK

FO

RM

UL

IR 1771 - VI SPT TAHUNAN PAJAK PENGHASILAN WAJIB PAJAK BADAN



NO NAMA NPWPJUMLAH PINJAMAN

TAHUN

JUMLAH BAGIAN A

%

(2) (3) (4) (5) (6)


NO NAMA N P W PJUMLAH PINJAMAN

TAHUN(Rupiah)

(3)

(2) (3) (4) (5) (6)

BUNGA/TH

%

BUNGA/TH

(Rupiah)

(Rupiah)

JUMLAH PENYERTAAN MODAL

%

(5) (6)

2 0 A

• LIST OF CAPITAL CONTRIBUTION IN AFFILIATION COMPANY

• LIST OF PAYABLE FROM SHARESHOLDER AND/OR AFFILIATION COMPANY

• LIST OF ACCOUNT RECEIVABLE TO SHARESHOLDER AND/OR AFFILIATION COMPANY

T I N :

TAXPAYER'S NAME :

ACCOUNTING PERIOD :

PART A : LIST OF CAPITAL CONTRIBUTION IN AFFILIATION COMPANY

(1)

PART B : LIST OF ACCOUNT PAYABLE FROM SHARESHOLDER AND/OR AFFILIATION COMPANY

(1)

PART C : LIST OF ACCOUNT RECEIVABLE TO SHARESHOLDER AND/OR AFFILIATION COMPANY

(1)


D.1.1.32.42

to

NO%

TA

XA

BL

E Y

EA

R

FO

RM

IDE

NT

ITY


(6)

YEARINTEREST/YR

(US$) %

(2) (3) (4) (5) (6)

IF NEEDED, ADDITIONAL PAGES MAY BE ADDED from


(2) (3) (4)

(US$)

(5) (6)

YEARINTEREST/YR

%

1771 - VI/$MINISTRY OF FINANCE OF THE


(US$)

AMOUNT OF CAPITAL CONTRIBUTIONT I NNAME


ATTACHMENT - VICORPORATE ANNUAL INCOME TAX RETURN


ADDRESS

(2) (3) (4) (5)

TOTAL PART A TPA

2 0 A A




N P W P :

NAMA WAJIB PAJAK :

PERIODE PEMBUKUAN :


(1)

JBA


(1)


(1)


D.1.1.32.42

JUMLAH BAGIAN A

NPWPJUMLAH PENYERTAAN MODAL

(US$)

(2) (3) (4) (5) (6)

(2) (3) (4) (5) (6)



TAHUNBUNGA/TH

(US$) %

TAHUNBUNGA/TH

(US$) %

(2) (3) (4) (5) (6)


IDE

NT

ITA

S

s.d.

NO%

NAMA ALAMAT

LAMPIRAN - VI

TA

HU

N P

AJ

AK

FO

RM

UL

IR 1771 - VI/$SPT TAHUNAN PAJAK PENGHASILAN WAJIB PAJAK BADAN





2 0 A A

2A

TAXABLE YEAR 2 0




(1)

NOTE: …………………………...…,



SPECIAL ATTACHMENT



NO


YEAR IDR(THIS TAXABLE YEAR) (CURRENT TAXABLE YEAR)

(IDR) (IDR) (IDR) (IDR) IDR *) IDR**)

(2) (3) (4) (5) (6) (7) (8) (9)

TOTAL

(……………………………………………………………)

TTL

2A

TAHUN PAJAK 2 0




(1)

J U M L A H

CATATAN : …………………………...…,

*) PINDAHKAN JUMLAH KOLOM INI KE FORMULIR 1771 HURUF A ANGKA 2

**) PINDAHKAN JUMLAH KOLOM INI KE FORMULIR 1771 HURUF E ANGKA 14 BUTIR b WAJIB PAJAK / KUASA

(……………………………………………………………)

JML

(8) (9)(2) (3) (4) (5) (6) (7)

(TAHUN BERJALAN)

(RUPIAH) (RUPIAH) (RUPIAH) (RUPIAH) RUPIAH *) RUPIAH **)

LAMPIRAN KHUSUS



NO


TAHUN RUPIAH(TAHUN PAJAK INI)

2B

TAXABLE YEAR 2 0




(1)

NOTE: …………………………...…,



SPECIAL ATTACHMENT



NO


YEAR US$(THIS TAXABLE YEAR) (CURRENT TAXABLE YEAR)

(US$) (US$) (US$) (US$) US$*) US$**)

(2) (3) (4) (5) (6) (7) (8) (9)

FOR CORPORATION PERMITTED TO MAINTAIN BOOKS OF ACCOUNT IN ENGLISH


(……………………………………………………………)

TOTAL TTL

2B

TAHUN PAJAK 2 0




(1)

J U M L A H

CATATAN : …………………………...…,

*) PINDAHKAN JUMLAH KOLOM INI KE FORMULIR 1771 /$ HURUF A ANGKA 2

**) PINDAHKAN JUMLAH KOLOM INI KE FORMULIR 1771 /$ HURUF E ANGKA 14 BUTIR b WAJIB PAJAK / KUASA

LAMPIRAN KHUSUS




NO


TAHUN US$(TAHUN PAJAK INI) (TAHUN BERJALAN)

(US$) (US$) (US$) (US$) US$ *) US$ **)

(2) (3) (4) (5) (6) (7) (8) (9)

(……………………………………………………………)

JML

3A

FOR TAXABLE YEAR

T I N:

TAXPAYER'S NAME :


1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4


a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

………………………,





(……………………………………………………………)

Types of Transaction Transaction's Value




SPECIAL ATTACHMENT

NameNo.

Name No.

Types of Relationship with

Taxpayer

3A

TAHUN PAJAK

NPWP:

Nama :


No

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4


No

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

JIKA FORMULIR INI TIDAK MENCUKUPI, DAPAT DIBUAT SENDIRI SESUAI DENGAN BENTUK INI ………………………,

WAJIB PAJAK / KUASA


LAMPIRAN KHUSUS

(……………………………………………………………)

4

5

2

3

Nama Mitra Transaksi Jenis Transaksi Nilai TransaksiMetode Penetapan Harga yang


1

4

5

2

3


Pajak


1

3B

FOR TAXABLE YEAR

T I N:

TAXPAYER'S NAME :


1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4


a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

………………………,



(……………………………………………………………)


shall be used Determination of MethodsNo. Name Types of Transaction Transaction's Value



SPECIAL ATTACHMENT




3B

NPWP:

Nama :


No

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4


No

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

………………………,


WAJIB PAJAK / KUASA

(……………………………………………………………)

Metode Penetapan Harga yang

digunakanAlasan Penggunaan MetodeNama Mitra Transaksi Jenis Transaksi Nilai Transaksi


Pajak

LAMPIRAN KHUSUS




TAHUN PAJAK


3A-2

FOR TAXABLE YEAR

TIN:

TAXPAYER'S NAME :

I

No

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g


YES NO

……………………….., ………………………


( ………………………… )



SPECIAL ATTACHMENT




3A-2

TAHUN PAJAK

NPWP:

Nama :

I

No

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g


Ya Tidak

……………………….., ………………………

WAJIB PAJAK / KUASA

( ………………………… )




5

4

3

2

1



LAMPIRAN KHUSUS

3B-2

FOR TAXABLE YEAR

TIN:

TAXPAYER'S NAME :

I

No

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g


YES NO

……………………….., ………………………


( ………………………… )

SPECIAL ATTACHMENT


FOR CORPORATION PERMITTED TO MAINTAIN BOOKS OF

ACCOUNT IN ENGLISH LANGUAGE AND US DOLLAR CURRENCY





3B-2

TAHUN PAJAK

NPWP:

Nama :

I

No

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g

a b c d e f g


Ya Tidak

……………………….., ………………………

WAJIB PAJAK / KUASA

( ………………………… )




LAMPIRAN KHUSUS





5A

FOR TAXABLE YEAR

T I N :

TAXPAYER'S NAME :

NOTE: ……………………………,






BRANCHES

(1) (2) (3) (4)

(……………………………………………………………)

5A

TAHUN PAJAK

N P W P :

NAMA WAJIB PAJAK :

CATATAN : ……………………………,


WAJIB PAJAK / KUASA

(……………………………………………………………)

(1) (2) (3) (4)


JUMLAH

CABANG

PEMBANTU

LAMPIRAN KHUSUS


2 0DAFTAR CABANG UTAMA PERUSAHAAN

5B

FOR TAXABLE YEAR

T I N :

TAXPAYER'S NAME :

NOTE: ……………………………,







BRANCHES

(1) (2) (3) (4)

(……………………………………………………………)

5B

TAHUN PAJAK

N P W P :

NAMA WAJIB PAJAK :

CATATAN : ……………………………,


WAJIB PAJAK / KUASA

LAMPIRAN KHUSUS



2 0

DAFTAR CABANG UTAMA PERUSAHAAN


JUMLAH

CABANG

PEMBANTU

(1) (2) (3) (4)

(……………………………………………………………)

7A


NOTES : ……………………,







SPECIAL ATTACHMENT

TAXABLE YEAR

2 0

(US$)

NO.

WITHHOLDING AGENT

TYPES OF INCOME

NET AMOUNTTAX DUE / PAID

IN FOREIGN COUNTRY

NAME ADDRESS(US$)

US$ FOREIGN EXCHANGE

(1) (2) (3) (4) (5) (6) (7) (8)

1,

2.

3.

4.

5.

6.

7.

8.

9.

10.

(……………………………………………………………)


FOREIGN TAX CREDIT

TAX CREDITABLE

COLUMN (6) IDR FILL WITH CONVERTION VALUE FROM THE NUMBER IN COLUMN (7) FOREIGN EXCHANGE USING EXCHANGE RATE PREVAILING AT

THE TIME OF TAX PAYMENT/TAX DUE IN FOREIGN COUNTRY

TOTAL TTL

7A


CATATAN : ……………………,


• KOLOM (6) RUPIAH DIISI DENGAN NILAI KONVERSI DARI ANGKA DALAM KOLOM (7) VALAS DENGAN MENGGUNAKAN KURS PAJAK YANG WAJIB PAJAK / KUASA



• PINDAHKAN HASIL PENJUMLAHAN KOLOM (8) KE FORMULIR 1771 HURUF C ANGKA 8.b.

• PINDAHKAN HASIL PENJUMLAHAN KOLOM (5) KE FORMULIR 1771-I Nomor 2.


JMLJUMLAH

(4)(3) (5) (6) (7) (8)

ALAMAT NO.

(1)

PEMOTONG PAJAK

NAMA

(2)

VALASRUPIAH

PAJAK YANG TERUTANG / DIBAYAR

DI LUAR NEGERIJENIS PENGHASILAN

JUMLAH NETO

(RUPIAH)

(……………………………………………………………)


(RUPIAH)

KREDIT PAJAK YANG

DAPAT DIPERHITUNGKAN


LAMPIRAN KHUSUS

TAHUN PAJAK

2 0

7B



2.

(7) (8)

1,

(1) (2) (3) (4) (5) (6)

TAX CREDITABLEIN FOREIGN COUNTRYNAME ADDRESS

(US $)US $ FOREIGN EXCHANGE (US $)

FOREIGN TAX CREDIT

NO.WITHHOLDING AGENT

TYPES OF INCOMENET AMOUNT TAX DUE / PAID


TAXABLE YEAR2 0

NOTES : ……………………,

TOTAL TTL

10.

9.

8.

7.

6.

5.

4.

3.








(……………………………………………………………)

7B

TAHUN PAJAK


CATATAN : ……………………,


• KOLOM (6) US $ DIISI DENGAN NILAI KONVERSI DARI ANGKA DALAM KOLOM (7) VALAS DENGAN MENGGUNAKAN KURS PAJAK YANG WAJIB PAJAK / KUASA



• PINDAHKAN HASIL PENJUMLAHAN KOLOM (8) KE FORMULIR 1771/$ HURUF C ANGKA 8.b.

• PINDAHKAN HASIL PENJUMLAHAN KOLOM (5) KE FORMULIR 1771-I/$ NOMOR 2.



LAMPIRAN KHUSUS



2 0


NO.

PEMOTONG PAJAK

JENIS PENGHASILAN

JUMLAH NETOPAJAK YANG TERUTANG / DIBAYAR

(1) (2) (3)

4.

2.

(……………………………………………………………)

10.

9.

KREDIT PAJAK YANGDI LUAR NEGERI

NAMA ALAMAT (US$) DAPAT DIPERHITUNGKAN

US$ VALAS (US$)

(4) (5) (6) (7) (8)

1,

3.

5.

6.

7.

8.

JUMLAH JML

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